Provider Demographics
NPI:1699530287
Name:STRAIGHT SMILE LLC
Entity type:Organization
Organization Name:STRAIGHT SMILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGUSKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-251-5410
Mailing Address - Street 1:3301 N THANKSGIVING WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7070
Mailing Address - Country:US
Mailing Address - Phone:866-765-2327
Mailing Address - Fax:
Practice Address - Street 1:1556 20TH ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3466
Practice Address - Country:US
Practice Address - Phone:866-765-2327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty