Provider Demographics
NPI:1669659181
Name:SMILES FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHIIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-348-3384
Mailing Address - Street 1:216 CUMBERLAND XING
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9000
Mailing Address - Country:US
Mailing Address - Phone:606-348-3384
Mailing Address - Fax:606-348-3384
Practice Address - Street 1:216 CUMBERLAND XING
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9000
Practice Address - Country:US
Practice Address - Phone:606-348-3384
Practice Address - Fax:606-348-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6190102100Medicaid