Healthcare Provider Details

I. General information

NPI: 1275315269
Provider Name (Legal Business Name): CLINICA SONRISAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 E 23RD ST
CHATTANOOGA TN
37408-2213
US

IV. Provider business mailing address

4803 HIXSON PIKE STE 101
HIXSON TN
37343-4486
US

V. Phone/Fax

Practice location:
  • Phone: 423-760-4000
  • Fax:
Mailing address:
  • Phone: 423-842-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BETH WEBB
Title or Position: DENTAL PARTNER
Credential: DDS
Phone: 423-842-0165