Provider Demographics
NPI:1912466582
Name:NORTH LIBERTY SMILES PLLC
Entity Type:Organization
Organization Name:NORTH LIBERTY SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-665-3373
Mailing Address - Street 1:6800 VISTA DEL NORTE RD NE APT 1526
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1364
Mailing Address - Country:US
Mailing Address - Phone:505-980-3107
Mailing Address - Fax:
Practice Address - Street 1:2 HAWKEYE DR STE 104
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-8202
Practice Address - Country:US
Practice Address - Phone:319-665-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1093813354OtherNPI