Provider Demographics
NPI:1316700115
Name:BIGSMILE INC.
Entity type:Organization
Organization Name:BIGSMILE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARTER
Authorized Official - Middle Name:MILAN
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-901-4700
Mailing Address - Street 1:1315 EMANCIPATION HWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4640
Mailing Address - Country:US
Mailing Address - Phone:540-899-1777
Mailing Address - Fax:540-899-2266
Practice Address - Street 1:1315 EMANCIPATION HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4640
Practice Address - Country:US
Practice Address - Phone:540-899-1777
Practice Address - Fax:540-899-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental