Provider Demographics
NPI:1740719004
Name:SMILE, IT'S HEALTHY L.L.C.
Entity type:Organization
Organization Name:SMILE, IT'S HEALTHY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-254-4065
Mailing Address - Street 1:4400 SHAWNEE MISSION PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2518
Mailing Address - Country:US
Mailing Address - Phone:913-254-4065
Mailing Address - Fax:
Practice Address - Street 1:4400 SHAWNEE MISSION PARKWAY
Practice Address - Street 2:SUITE 208
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205
Practice Address - Country:US
Practice Address - Phone:913-254-4065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty