Provider Demographics
NPI:1700567831
Name:SIGNATURE SMILE DESIGNS INC
Entity Type:Organization
Organization Name:SIGNATURE SMILE DESIGNS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROLF
Authorized Official - Middle Name:
Authorized Official - Last Name:LAEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-671-7996
Mailing Address - Street 1:197 INTERSTATE PKWY
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1013
Mailing Address - Country:US
Mailing Address - Phone:814-368-4492
Mailing Address - Fax:
Practice Address - Street 1:197 INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1013
Practice Address - Country:US
Practice Address - Phone:814-368-4492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty