Provider Demographics
NPI:1881475275
Name:SMILE LINE STUDIO LLC
Entity type:Organization
Organization Name:SMILE LINE STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-602-4423
Mailing Address - Street 1:11526 ASH STREET
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211
Mailing Address - Country:US
Mailing Address - Phone:913-602-4423
Mailing Address - Fax:
Practice Address - Street 1:11526 ASH STREET
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-602-4423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty