Provider Demographics
NPI:1881754026
Name:CHANGING SMILES INC
Entity type:Organization
Organization Name:CHANGING SMILES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLLIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-492-1790
Mailing Address - Street 1:325 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-1283
Mailing Address - Country:US
Mailing Address - Phone:937-492-1790
Mailing Address - Fax:937-492-2167
Practice Address - Street 1:325 2ND AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1283
Practice Address - Country:US
Practice Address - Phone:937-492-1790
Practice Address - Fax:937-492-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0144201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty