Provider Demographics
NPI:1871203877
Name:SMILES OF ALASKA LLC
Entity type:Organization
Organization Name:SMILES OF ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:CHI
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-262-6466
Mailing Address - Street 1:880 SEVEN HILLS DR STE 180
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4380
Mailing Address - Country:US
Mailing Address - Phone:702-478-8869
Mailing Address - Fax:
Practice Address - Street 1:880 SEVEN HILLS DR STE 180
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4380
Practice Address - Country:US
Practice Address - Phone:702-478-8869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty