Provider Demographics
NPI:1659094548
Name:SANDY SMILES, PLLC
Entity Type:Organization
Organization Name:SANDY SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:ZWICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-816-4548
Mailing Address - Street 1:150 LATONKA DR
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-9360
Mailing Address - Country:US
Mailing Address - Phone:724-816-4548
Mailing Address - Fax:
Practice Address - Street 1:824 EGLIN PKWY NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2530
Practice Address - Country:US
Practice Address - Phone:850-244-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty