Provider Demographics
NPI:1871942391
Name:PEDIATRIC SMILES, LLC
Entity type:Organization
Organization Name:PEDIATRIC SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-707-7915
Mailing Address - Street 1:19 PROMENADE ST
Mailing Address - Street 2:UNIT 201
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7037
Mailing Address - Country:US
Mailing Address - Phone:843-707-7915
Mailing Address - Fax:
Practice Address - Street 1:19 PROMENADE ST
Practice Address - Street 2:UNIT 201
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7037
Practice Address - Country:US
Practice Address - Phone:843-707-7915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8543-8691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty