Provider Demographics
NPI:1780849240
Name:KIDS SMILES INC
Entity Type:Organization
Organization Name:KIDS SMILES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDDS
Authorized Official - Phone:508-771-0920
Mailing Address - Street 1:407 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5121
Mailing Address - Country:US
Mailing Address - Phone:508-771-0920
Mailing Address - Fax:508-771-2569
Practice Address - Street 1:407 NORTH ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5121
Practice Address - Country:US
Practice Address - Phone:508-771-0920
Practice Address - Fax:508-771-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty