Provider Demographics
NPI:1316347826
Name:SMILES FOR MILES FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:SMILES FOR MILES FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SALM
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-526-0655
Mailing Address - Street 1:S22W22660 BROADWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-8100
Mailing Address - Country:US
Mailing Address - Phone:414-526-0655
Mailing Address - Fax:
Practice Address - Street 1:S22W22660 BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-8100
Practice Address - Country:US
Practice Address - Phone:414-526-0655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6060261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental