Healthcare Provider Details

I. General information

NPI: 1992645063
Provider Name (Legal Business Name): SMART SMILES DIGITAL LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4053 REDPETAL LN
BATAVIA OH
45103-2860
US

IV. Provider business mailing address

4053 REDPETAL LN
BATAVIA OH
45103-2860
US

V. Phone/Fax

Practice location:
  • Phone: 859-412-6782
  • Fax:
Mailing address:
  • Phone: 859-412-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name: ERDRY MAGALIS TORRES
Title or Position: OWNER
Credential:
Phone: 859-412-6782