Provider Demographics
NPI:1851908776
Name:SMILES DENTAL P.C.
Entity Type:Organization
Organization Name:SMILES DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-371-9552
Mailing Address - Street 1:510 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5231
Mailing Address - Country:US
Mailing Address - Phone:402-371-9552
Mailing Address - Fax:
Practice Address - Street 1:510 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5231
Practice Address - Country:US
Practice Address - Phone:402-371-9552
Practice Address - Fax:402-371-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty