Provider Demographics
NPI:1790027134
Name:HEALTHY SMILES FOREVER, LLC
Entity Type:Organization
Organization Name:HEALTHY SMILES FOREVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-227-5222
Mailing Address - Street 1:5576 SAPPHIRE LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-6000
Mailing Address - Country:US
Mailing Address - Phone:763-227-5222
Mailing Address - Fax:
Practice Address - Street 1:5576 SAPPHIRE LOOP
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-6000
Practice Address - Country:US
Practice Address - Phone:763-227-5222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK13751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty