Provider Demographics
NPI:1326858119
Name:SMILE BURNS
Entity type:Organization
Organization Name:SMILE BURNS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MINGUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-382-6565
Mailing Address - Street 1:711 PONDEROSA VLG
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-2315
Mailing Address - Country:US
Mailing Address - Phone:541-589-4202
Mailing Address - Fax:
Practice Address - Street 1:711 PONDEROSA VLG
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-2315
Practice Address - Country:US
Practice Address - Phone:541-589-4202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. KELLEY MINGUS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty