Provider Demographics
NPI:1154800068
Name:SIGNATURE SMILES, LLC
Entity type:Organization
Organization Name:SIGNATURE SMILES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DDS - PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-292-6050
Mailing Address - Street 1:2801 WADE HAMPTON BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-2758
Mailing Address - Country:US
Mailing Address - Phone:864-292-6050
Mailing Address - Fax:
Practice Address - Street 1:2801 WADE HAMPTON BLVD STE 118
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2758
Practice Address - Country:US
Practice Address - Phone:864-292-6050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty