Provider Demographics
NPI:1245927359
Name:CLEAR SMILE, PLLC
Entity type:Organization
Organization Name:CLEAR SMILE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAKOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-772-3893
Mailing Address - Street 1:15509 HARBOR POINT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-9515
Mailing Address - Country:US
Mailing Address - Phone:501-944-1933
Mailing Address - Fax:
Practice Address - Street 1:15509 HARBOR POINT LN
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-9515
Practice Address - Country:US
Practice Address - Phone:501-944-1933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty