Healthcare Provider Details

I. General information

NPI: 1942810882
Provider Name (Legal Business Name): LEXINGTON SMILES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S RANDOLPH ST
LEXINGTON VA
24450-2065
US

IV. Provider business mailing address

123 S RANDOLPH ST
LEXINGTON VA
24450-2065
US

V. Phone/Fax

Practice location:
  • Phone: 540-458-0410
  • Fax:
Mailing address:
  • Phone: 540-458-0410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIN CASSILLY
Title or Position: DENTIST
Credential: DDS
Phone: 540-458-0410