Provider Demographics
NPI:1992387559
Name:SMILES ORTHODONTICS LLC
Entity Type:Organization
Organization Name:SMILES ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORANTLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:316-684-5184
Mailing Address - Street 1:7015 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1943
Mailing Address - Country:US
Mailing Address - Phone:316-684-5184
Mailing Address - Fax:316-684-5197
Practice Address - Street 1:7015 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1943
Practice Address - Country:US
Practice Address - Phone:316-684-5184
Practice Address - Fax:316-684-5197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty