Provider Demographics
NPI:1174407506
Name:MIAMI VALLEY SMILES OF HAMILTON LLC
Entity type:Organization
Organization Name:MIAMI VALLEY SMILES OF HAMILTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-578-4206
Mailing Address - Street 1:4200 AERO DR STE K
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8823
Mailing Address - Country:US
Mailing Address - Phone:614-578-4206
Mailing Address - Fax:
Practice Address - Street 1:2201 NW WASHINGTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-5835
Practice Address - Country:US
Practice Address - Phone:513-889-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental