Provider Demographics
NPI:1932716412
Name:SMILES BY JB
Entity Type:Organization
Organization Name:SMILES BY JB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-408-9500
Mailing Address - Street 1:1822 E NC HIGHWAY 54 STE 100
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-3210
Mailing Address - Country:US
Mailing Address - Phone:919-484-0800
Mailing Address - Fax:
Practice Address - Street 1:1822 E NC HIGHWAY 54 STE 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-3210
Practice Address - Country:US
Practice Address - Phone:919-484-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty