Provider Demographics
NPI:1285093385
Name:SMILES DENTAL GROUP, PC
Entity type:Organization
Organization Name:SMILES DENTAL GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-332-8646
Mailing Address - Street 1:900 FIR ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2544
Mailing Address - Country:US
Mailing Address - Phone:360-261-6094
Mailing Address - Fax:360-423-3343
Practice Address - Street 1:820 OCEAN BEACH HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4080
Practice Address - Country:US
Practice Address - Phone:360-261-6094
Practice Address - Fax:360-423-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No122400000XDental ProvidersDenturistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty