Provider Demographics
NPI:1891952982
Name:LITTLE SMILES PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:LITTLE SMILES PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.C., PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:PELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-235-0313
Mailing Address - Street 1:8708 SE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7331
Mailing Address - Country:US
Mailing Address - Phone:503-235-0313
Mailing Address - Fax:
Practice Address - Street 1:8708 SE 17TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7331
Practice Address - Country:US
Practice Address - Phone:503-235-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-17
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD88891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty