Provider Demographics
NPI:1699841882
Name:ALLSMILES FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:ALLSMILES FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKKAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-734-5303
Mailing Address - Street 1:95 WOLF CREEK BLVD
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4962
Mailing Address - Country:US
Mailing Address - Phone:302-734-5303
Mailing Address - Fax:302-734-5305
Practice Address - Street 1:95 WOLF CREEK BLVD
Practice Address - Street 2:SUITE # 3
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4962
Practice Address - Country:US
Practice Address - Phone:302-734-5303
Practice Address - Fax:302-734-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000040831Medicaid