Provider Demographics
NPI:1609310127
Name:ALL ABOUT SMILES DENTAL CLINIC
Entity type:Organization
Organization Name:ALL ABOUT SMILES DENTAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-922-4561
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:OR
Mailing Address - Zip Code:97882-1133
Mailing Address - Country:US
Mailing Address - Phone:541-922-4561
Mailing Address - Fax:541-922-2317
Practice Address - Street 1:200 6TH ST
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:OR
Practice Address - Zip Code:97882-3004
Practice Address - Country:US
Practice Address - Phone:541-922-4561
Practice Address - Fax:541-922-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD5033261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR048074Medicaid