Provider Demographics
NPI:1568881852
Name:I SMILE DENTAL DESIGNS
Entity Type:Organization
Organization Name:I SMILE DENTAL DESIGNS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-355-2202
Mailing Address - Street 1:420 E SOUTH TEMPLE
Mailing Address - Street 2:SUITE # 410
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1319
Mailing Address - Country:US
Mailing Address - Phone:801-355-2202
Mailing Address - Fax:801-355-9420
Practice Address - Street 1:420 E SOUTH TEMPLE
Practice Address - Street 2:SUITE # 410
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1319
Practice Address - Country:US
Practice Address - Phone:801-355-2202
Practice Address - Fax:801-355-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty