Provider Demographics
NPI:1669853487
Name:KLAMATH SMILES, LLC
Entity Type:Organization
Organization Name:KLAMATH SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-882-9039
Mailing Address - Street 1:2301 MOUNTAIN VIEW BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1137
Mailing Address - Country:US
Mailing Address - Phone:541-882-9039
Mailing Address - Fax:866-437-2057
Practice Address - Street 1:2301 MOUNTAIN VIEW BLVD STE D
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1137
Practice Address - Country:US
Practice Address - Phone:541-882-9039
Practice Address - Fax:866-437-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental