Provider Demographics
NPI:1851489835
Name:SMILE CENTER, P.A.
Entity Type:Organization
Organization Name:SMILE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:CENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:479-751-8780
Mailing Address - Street 1:920 W EMMA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4472
Mailing Address - Country:US
Mailing Address - Phone:479-751-8780
Mailing Address - Fax:479-751-0465
Practice Address - Street 1:920 W EMMA AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4472
Practice Address - Country:US
Practice Address - Phone:479-751-8780
Practice Address - Fax:479-751-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
799894OtherUNITED CONCORDIA