Provider Demographics
NPI:1982148128
Name:DENTAL SMILE DESIGN
Entity Type:Organization
Organization Name:DENTAL SMILE DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:505-872-0327
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE
Mailing Address - Street 2:BLDG. C STE. D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1521
Mailing Address - Country:US
Mailing Address - Phone:505-872-0327
Mailing Address - Fax:505-884-1479
Practice Address - Street 1:7520 MONTGOMERY BLVD NE
Practice Address - Street 2:BLDG. C STE. D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1521
Practice Address - Country:US
Practice Address - Phone:505-872-0327
Practice Address - Fax:505-884-1479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY & COSMETIC DENTAL DESIGN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty