Healthcare Provider Details

I. General information

NPI: 1922587757
Provider Name (Legal Business Name): SMILENORTON INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 NORTON RD
COLUMBUS OH
43228-1711
US

IV. Provider business mailing address

17 NORTON RD
COLUMBUS OH
43228-1711
US

V. Phone/Fax

Practice location:
  • Phone: 614-870-3337
  • Fax: 614-870-3339
Mailing address:
  • Phone: 614-870-3337
  • Fax: 614-870-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30023039
License Number StateOH

VIII. Authorized Official

Name: PAVLA FLANAGAN
Title or Position: RECEPTIONIST
Credential:
Phone: 614-870-3337