Provider Demographics
NPI:1740779792
Name:SMILE DOCTORS OF OHIO, INC.
Entity Type:Organization
Organization Name:SMILE DOCTORS OF OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARGESON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:614-761-9777
Mailing Address - Street 1:10220 SAWMILL PKWY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9189
Mailing Address - Country:US
Mailing Address - Phone:614-761-9777
Mailing Address - Fax:
Practice Address - Street 1:10220 SAWMILL PKWY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9189
Practice Address - Country:US
Practice Address - Phone:614-761-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0251991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty