Provider Demographics
NPI:1821612797
Name:GOOD LIFE SMILES, PC
Entity Type:Organization
Organization Name:GOOD LIFE SMILES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:402-502-1700
Mailing Address - Street 1:18101 CHICAGO ST STE 107
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4408
Mailing Address - Country:US
Mailing Address - Phone:402-502-1700
Mailing Address - Fax:
Practice Address - Street 1:18101 CHICAGO STREET
Practice Address - Street 2:SUITE #107
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68022
Practice Address - Country:US
Practice Address - Phone:402-590-5365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty