Provider Demographics
NPI:1881946069
Name:TIMELESS SMILES MOBILE DENTISTRY
Entity type:Organization
Organization Name:TIMELESS SMILES MOBILE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:H
Authorized Official - Last Name:STORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-263-4646
Mailing Address - Street 1:3090 E HIGHWAY 27
Mailing Address - Street 2:SUITE B
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-9441
Mailing Address - Country:US
Mailing Address - Phone:704-263-4646
Mailing Address - Fax:704-263-4696
Practice Address - Street 1:3090 E HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-9441
Practice Address - Country:US
Practice Address - Phone:704-263-4646
Practice Address - Fax:704-263-4696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAM E. NAYLOR DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty