Provider Demographics
NPI:1942431655
Name:CLEVELAND SMILES PLLC
Entity Type:Organization
Organization Name:CLEVELAND SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MERIDETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-471-5225
Mailing Address - Street 1:1390 W CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-4044
Mailing Address - Country:US
Mailing Address - Phone:918-358-2300
Mailing Address - Fax:
Practice Address - Street 1:1390 W CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-4044
Practice Address - Country:US
Practice Address - Phone:918-358-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty