Provider Demographics
NPI:1619606605
Name:SWEET SMILES LLC
Entity Type:Organization
Organization Name:SWEET SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YI
Authorized Official - Middle Name:
Authorized Official - Last Name:CONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-877-9007
Mailing Address - Street 1:751 LIEBER WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8741
Mailing Address - Country:US
Mailing Address - Phone:303-877-9007
Mailing Address - Fax:
Practice Address - Street 1:8275 S EASTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2543
Practice Address - Country:US
Practice Address - Phone:303-877-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty