Provider Demographics
NPI:1629161591
Name:PERFECT-A-SMILE DENTAL GROUP
Entity Type:Organization
Organization Name:PERFECT-A-SMILE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:SLATEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-708-0900
Mailing Address - Street 1:16716 CHILLICOTHE RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4595
Mailing Address - Country:US
Mailing Address - Phone:440-708-0900
Mailing Address - Fax:440-708-0904
Practice Address - Street 1:16716 CHILLICOTHE RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4595
Practice Address - Country:US
Practice Address - Phone:440-708-0900
Practice Address - Fax:440-708-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-45501223G0001X
OH30-02-00901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDR9368011Medicare PIN