Provider Demographics
NPI:1184154155
Name:MONROE SMILES INC
Entity type:Organization
Organization Name:MONROE SMILES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-794-8580
Mailing Address - Street 1:14650 N KELSEY ST # 104-105
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1456
Mailing Address - Country:US
Mailing Address - Phone:360-794-8580
Mailing Address - Fax:844-470-1798
Practice Address - Street 1:14650 N KELSEY ST # 104-105
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1456
Practice Address - Country:US
Practice Address - Phone:360-794-8580
Practice Address - Fax:844-470-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD000092141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty