Provider Demographics
NPI:1720749120
Name:FCD SMILES, PC
Entity Type:Organization
Organization Name:FCD SMILES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-366-8141
Mailing Address - Street 1:1947 E MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5467
Mailing Address - Country:US
Mailing Address - Phone:402-727-8700
Mailing Address - Fax:402-727-8700
Practice Address - Street 1:1947 E MILITARY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5467
Practice Address - Country:US
Practice Address - Phone:402-727-8700
Practice Address - Fax:402-727-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty