Provider Demographics
NPI:1942308325
Name:SOUTHSIDE SMILES, L.L.C.
Entity Type:Organization
Organization Name:SOUTHSIDE SMILES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-274-4746
Mailing Address - Street 1:9138 ARLON ST
Mailing Address - Street 2:LIBERTY VILLAGE BUILDING, SUITE B1
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3822
Mailing Address - Country:US
Mailing Address - Phone:907-274-4746
Mailing Address - Fax:907-274-4745
Practice Address - Street 1:9138 ARLON ST
Practice Address - Street 2:LIBERTY VILLAGE BUILDING, SUITE B1
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3822
Practice Address - Country:US
Practice Address - Phone:907-274-4746
Practice Address - Fax:907-274-4745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK1050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty