Provider Demographics
NPI:1528453214
Name:STRAIGHT SMILES, LLC
Entity type:Organization
Organization Name:STRAIGHT SMILES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDONT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-665-1115
Mailing Address - Street 1:202 NE 181ST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6664
Mailing Address - Country:US
Mailing Address - Phone:503-665-1115
Mailing Address - Fax:
Practice Address - Street 1:202 NE 181ST AVE
Practice Address - Street 2:STE C
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6664
Practice Address - Country:US
Practice Address - Phone:503-665-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9440261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental