Provider Demographics
NPI:1205236189
Name:SMILES BY DESIGN PC
Entity type:Organization
Organization Name:SMILES BY DESIGN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:AXVIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-223-5500
Mailing Address - Street 1:301 E FRONT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5601
Mailing Address - Country:US
Mailing Address - Phone:701-223-5500
Mailing Address - Fax:701-222-2218
Practice Address - Street 1:301 E FRONT AVE STE 105
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5601
Practice Address - Country:US
Practice Address - Phone:701-223-5500
Practice Address - Fax:701-222-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty