Healthcare Provider Details

I. General information

NPI: 1528212834
Provider Name (Legal Business Name): SMILEWRIGHT FAMILY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 CONTINENTAL DR
SALEM OH
44460-2509
US

IV. Provider business mailing address

303 CONTINENTAL DR P.O. BOX 948
SALEM OH
44460-2509
US

V. Phone/Fax

Practice location:
  • Phone: 330-332-0366
  • Fax:
Mailing address:
  • Phone: 330-332-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15484
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19125
License Number StateOH

VIII. Authorized Official

Name: DR. GREGORY BENJAMIN IADEROSA
Title or Position: OWNER
Credential: DDS
Phone: 330-332-0366