Provider Demographics
NPI:1659705457
Name:SMILING FACES OF LACOMBE LLC
Entity Type:Organization
Organization Name:SMILING FACES OF LACOMBE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DR. TRACY
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:CREAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-621-7412
Mailing Address - Street 1:27403 HIGHWAY 190
Mailing Address - Street 2:SUITE A
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-6401
Mailing Address - Country:US
Mailing Address - Phone:504-621-7412
Mailing Address - Fax:
Practice Address - Street 1:27403 HIGHWAY 190
Practice Address - Street 2:SUITE A
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-6401
Practice Address - Country:US
Practice Address - Phone:504-621-7412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty