Provider Demographics
NPI:1386922565
Name:VILLAGE SMILES
Entity type:Organization
Organization Name:VILLAGE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-793-8881
Mailing Address - Street 1:26 MAIN ST
Mailing Address - Street 2:P.O. BOX 74
Mailing Address - City:LIMERICK
Mailing Address - State:ME
Mailing Address - Zip Code:04048-3534
Mailing Address - Country:US
Mailing Address - Phone:207-793-8881
Mailing Address - Fax:
Practice Address - Street 1:26 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:ME
Practice Address - Zip Code:04048-3534
Practice Address - Country:US
Practice Address - Phone:207-793-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEIPH30124Q00000X
MEPHS886124Q00000X
MELAN30124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty