Healthcare Provider Details

I. General information

NPI: 1255249520
Provider Name (Legal Business Name): SMILE STUDIO OF REHOBOTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19411 PLANTATIONS RD BLDG 4
REHOBOTH BEACH DE
19971-4497
US

IV. Provider business mailing address

19411 PLANTATIONS RD BLDG 4
REHOBOTH BEACH DE
19971-4497
US

V. Phone/Fax

Practice location:
  • Phone: 302-715-0020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNY ORGANISTA
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 302-392-2449