Provider Demographics
NPI:1982026407
Name:SMILES 4 KIDS LACEY. PC
Entity type:Organization
Organization Name:SMILES 4 KIDS LACEY. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-603-4779
Mailing Address - Street 1:3315 PACIFIC AVENUE SE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:OLIMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501
Mailing Address - Country:US
Mailing Address - Phone:360-491-1414
Mailing Address - Fax:
Practice Address - Street 1:3315 PACIFIC AVENUE SE
Practice Address - Street 2:SUITE A1
Practice Address - City:OLIMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-491-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602827271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty