Provider Demographics
NPI:1992972368
Name:SMILES ONEONTA
Entity type:Organization
Organization Name:SMILES ONEONTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOELY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIM-EBERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:205-274-2414
Mailing Address - Street 1:27550 STATE HIGHWAY 75 STE 104
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-3204
Mailing Address - Country:US
Mailing Address - Phone:205-274-2414
Mailing Address - Fax:
Practice Address - Street 1:27550 STATE HIGHWAY 75 STE 104
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-3204
Practice Address - Country:US
Practice Address - Phone:205-274-2414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty