Provider Demographics
NPI:1649762824
Name:SMILE ARTISTRY
Entity Type:Organization
Organization Name:SMILE ARTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:PETROVICH
Authorized Official - Last Name:LYASHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-348-5245
Mailing Address - Street 1:12875 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5152
Mailing Address - Country:US
Mailing Address - Phone:503-348-5245
Mailing Address - Fax:
Practice Address - Street 1:518 SE OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4897
Practice Address - Country:US
Practice Address - Phone:503-640-9310
Practice Address - Fax:503-648-3794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10146261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental