Healthcare Provider Details

I. General information

NPI: 1992110746
Provider Name (Legal Business Name): HOT SMILE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S JAMES RD
COLUMBUS OH
43213-1621
US

IV. Provider business mailing address

60 S JAMES RD
COLUMBUS OH
43213-1621
US

V. Phone/Fax

Practice location:
  • Phone: 614-235-5560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17498
License Number StateOH

VIII. Authorized Official

Name: DR. SUSAN KAY WILSON
Title or Position: OWNER
Credential: DDS
Phone: 614-235-5560