Provider Demographics
NPI:1730485871
Name:ALL ABOUT SMILES
Entity Type:Organization
Organization Name:ALL ABOUT SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-423-0779
Mailing Address - Street 1:659 S BREIEL BLVD UNIT 27
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5113
Mailing Address - Country:US
Mailing Address - Phone:513-423-0779
Mailing Address - Fax:513-423-7731
Practice Address - Street 1:659 S BREIEL BLVD UNIT 27
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5113
Practice Address - Country:US
Practice Address - Phone:513-423-0779
Practice Address - Fax:513-423-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019191305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service