Provider Demographics
NPI:1285353094
Name:NILES SMILES DENTAL, PLLC
Entity type:Organization
Organization Name:NILES SMILES DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-879-5151
Mailing Address - Street 1:47 COMMERCE DR # 102
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8038
Mailing Address - Country:US
Mailing Address - Phone:802-879-5151
Mailing Address - Fax:
Practice Address - Street 1:47 COMMERCE DR # 102
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-8038
Practice Address - Country:US
Practice Address - Phone:802-879-5151
Practice Address - Fax:802-879-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty