Provider Demographics
NPI:1992054167
Name:SMILES BY CRISP, PLLC
Entity type:Organization
Organization Name:SMILES BY CRISP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-570-5101
Mailing Address - Street 1:9220 HIGHWAY 71 S
Mailing Address - Street 2:SUITE A5
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-9117
Mailing Address - Country:US
Mailing Address - Phone:479-646-1245
Mailing Address - Fax:479-646-0592
Practice Address - Street 1:9220 HIGHWAY 71 S
Practice Address - Street 2:SUITE A5
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9117
Practice Address - Country:US
Practice Address - Phone:479-646-1245
Practice Address - Fax:479-646-0592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR29291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty