Healthcare Provider Details

I. General information

NPI: 1609206580
Provider Name (Legal Business Name): SMILES FOR LIFE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 LEBANON RD. SUITE B
CHARLOTTE NC
28227
US

IV. Provider business mailing address

7215 LEBANON RD. SUITE B
CHARLOTTE NC
28227
US

V. Phone/Fax

Practice location:
  • Phone: 704-545-2018
  • Fax: 704-545-2008
Mailing address:
  • Phone: 704-545-2018
  • Fax: 704-545-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7891
License Number StateNC

VIII. Authorized Official

Name: WESLEY L. ROBINSON
Title or Position: OWNER, PRESIDENT
Credential: DMD, P.A.
Phone: 704-545-2018