Provider Demographics
NPI:1811079890
Name:SMILES NORTHWEST LLC
Entity type:Organization
Organization Name:SMILES NORTHWEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-644-7763
Mailing Address - Street 1:3800 SW CEDAR HILLS BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2003
Mailing Address - Country:US
Mailing Address - Phone:503-644-7763
Mailing Address - Fax:503-646-3992
Practice Address - Street 1:3800 SW CEDAR HILLS BLVD STE 180
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2003
Practice Address - Country:US
Practice Address - Phone:503-644-7763
Practice Address - Fax:503-646-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD5975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty