Provider Demographics
NPI:1194531327
Name:SMILE SOLUTIONS OF KANSAS LLC
Entity type:Organization
Organization Name:SMILE SOLUTIONS OF KANSAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORANTLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-707-5766
Mailing Address - Street 1:611 N BROADWAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-3928
Mailing Address - Country:US
Mailing Address - Phone:423-707-5766
Mailing Address - Fax:
Practice Address - Street 1:611 N BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-3928
Practice Address - Country:US
Practice Address - Phone:423-707-5766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice