Provider Demographics
NPI:1922606490
Name:SMILE PLEASANT HILL LLC
Entity Type:Organization
Organization Name:SMILE PLEASANT HILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULLIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KINSER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-598-2523
Mailing Address - Street 1:1260 GLEN LAURA RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-7106
Mailing Address - Country:US
Mailing Address - Phone:813-598-2523
Mailing Address - Fax:
Practice Address - Street 1:828 PLEASANT HILL RD NW STE 10
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2757
Practice Address - Country:US
Practice Address - Phone:678-825-2332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental