Provider Demographics
NPI:1609298942
Name:SMILE DENTURES, PLLC
Entity Type:Organization
Organization Name:SMILE DENTURES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED DENTURIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:BECKNER
Authorized Official - Suffix:II
Authorized Official - Credentials:LD
Authorized Official - Phone:503-440-6540
Mailing Address - Street 1:3925 ABBEY LANE
Mailing Address - Street 2:STE 7
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-2235
Mailing Address - Country:US
Mailing Address - Phone:503-836-7711
Mailing Address - Fax:951-888-6684
Practice Address - Street 1:3925 ABBEY LANE
Practice Address - Street 2:STE 7
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-2235
Practice Address - Country:US
Practice Address - Phone:503-836-7711
Practice Address - Fax:951-888-8668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-10157767122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty