Provider Demographics
NPI:1588963615
Name:FUTURE SMILES
Entity type:Organization
Organization Name:FUTURE SMILES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:702-889-3763
Mailing Address - Street 1:3074 ARVILLE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7490
Mailing Address - Country:US
Mailing Address - Phone:702-889-3763
Mailing Address - Fax:
Practice Address - Street 1:3074 ARVILLE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7490
Practice Address - Country:US
Practice Address - Phone:702-889-3763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUTURE SMILES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-15
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3419124Q00000X
NV3636124Q00000X
NV3626124Q00000X
NV10099124Q00000X
NV101718124Q00000X
NV2713124Q00000X
NV4380124Q00000X
NV4447124Q00000X
NV3646124Q00000X
NV3420124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1124319181Medicaid
NV1083903017Medicaid
NV1548322191Medicaid
NV1265706022Medicaid
NV1437479565Medicaid
NV1841520574Medicaid
NV1891090841Medicaid
NV1013216340Medicaid
NV1245561133Medicaid
NV1780970871Medicaid