Provider Demographics
NPI:1598878142
Name:SMILE CLINIC, S.C.
Entity Type:Organization
Organization Name:SMILE CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:BEHRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-682-9131
Mailing Address - Street 1:1602 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-1858
Mailing Address - Country:US
Mailing Address - Phone:920-682-9131
Mailing Address - Fax:920-682-9799
Practice Address - Street 1:1602 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-1858
Practice Address - Country:US
Practice Address - Phone:920-682-9131
Practice Address - Fax:920-682-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI840836WOtherUNITED CONCORDIA
WI1788OtherDELTA DENTAL
WI389569136002OtherBLUE CROSS BLUE SHIELD