Provider Demographics
NPI:1588388847
Name:CANANDAIGUA SMILES, LLC
Entity type:Organization
Organization Name:CANANDAIGUA SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-248-5100
Mailing Address - Street 1:195 PARRISH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1693
Mailing Address - Country:US
Mailing Address - Phone:585-394-4058
Mailing Address - Fax:585-394-6108
Practice Address - Street 1:195 PARRISH ST STE 140
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1693
Practice Address - Country:US
Practice Address - Phone:585-394-4058
Practice Address - Fax:585-394-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty