Provider Demographics
NPI:1740904853
Name:KARRIE ON SMILES
Entity type:Organization
Organization Name:KARRIE ON SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDHAP
Authorized Official - Prefix:MS
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-273-4515
Mailing Address - Street 1:201 N BRAND BLVD UNIT 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3590
Mailing Address - Country:US
Mailing Address - Phone:818-273-4515
Mailing Address - Fax:
Practice Address - Street 1:201 N BRAND BLVD UNIT 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3590
Practice Address - Country:US
Practice Address - Phone:818-273-4515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental