Healthcare Provider Details

I. General information

NPI: 1871529222
Provider Name (Legal Business Name): SNIFFLES & SMILES PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E MAIN ST
SAINT CLAIRSVILLE OH
43950-1586
US

IV. Provider business mailing address

135 E MAIN ST
SAINT CLAIRSVILLE OH
43950-1586
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-9470
  • Fax: 740-695-3674
Mailing address:
  • Phone: 740-695-9470
  • Fax: 740-695-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35080667
License Number StateOH

VIII. Authorized Official

Name: DR. MARK J WILSON
Title or Position: PRESIDENT
Credential: M.D
Phone: 740-695-9470