Healthcare Provider Details

I. General information

NPI: 1144843939
Provider Name (Legal Business Name): SMILE MARIANAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JOSE CDA BUILDING
SAIPAN MP
96950-9695
US

IV. Provider business mailing address

PMB 121 BOX 10001
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-235-2378
  • Fax:
Mailing address:
  • Phone: 670-235-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. FLOR R. URENA
Title or Position: ACCOUNTANT
Credential:
Phone: 670-235-2378