Provider Demographics
NPI:1104118744
Name:FAMILY SMILES, LLC
Entity type:Organization
Organization Name:FAMILY SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:VONWESTERNHAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-759-8808
Mailing Address - Street 1:5505 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1601
Mailing Address - Country:US
Mailing Address - Phone:505-843-6060
Mailing Address - Fax:505-255-0925
Practice Address - Street 1:5505 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1601
Practice Address - Country:US
Practice Address - Phone:505-843-6060
Practice Address - Fax:505-255-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD34641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty