Provider Demographics
NPI:1740965532
Name:SMUIN DENTAL LLC
Entity type:Organization
Organization Name:SMUIN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-781-2805
Mailing Address - Street 1:317 W 100 S
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2517
Mailing Address - Country:US
Mailing Address - Phone:435-781-2805
Mailing Address - Fax:435-781-1656
Practice Address - Street 1:317 W 100 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2517
Practice Address - Country:US
Practice Address - Phone:435-781-2805
Practice Address - Fax:435-781-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental