Provider Demographics
NPI:1598340978
Name:FAMILY SMILES LLC
Entity Type:Organization
Organization Name:FAMILY SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FUTURE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-257-7014
Mailing Address - Street 1:1750 YOUNGS RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-9451
Mailing Address - Country:US
Mailing Address - Phone:443-257-7014
Mailing Address - Fax:
Practice Address - Street 1:335 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2505
Practice Address - Country:US
Practice Address - Phone:717-632-2565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental