Provider Demographics
NPI:1811537665
Name:MY SMILE EXPERIENCE P.C.
Entity Type:Organization
Organization Name:MY SMILE EXPERIENCE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALPHONSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-485-0024
Mailing Address - Street 1:99 ROCKINGHAM PARK BLVD # W111B
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2900
Mailing Address - Country:US
Mailing Address - Phone:603-485-0024
Mailing Address - Fax:
Practice Address - Street 1:99 ROCKINGHAM PARK BLVD # W111B
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2900
Practice Address - Country:US
Practice Address - Phone:603-485-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty