Healthcare Provider Details

I. General information

NPI: 1851536213
Provider Name (Legal Business Name): OKIDA SMILES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9507 HULL STREET RD SUITE G-1
RICHMOND VA
23236-1476
US

IV. Provider business mailing address

9507 HULL STREET RD SUITE G-1
RICHMOND VA
23236-1476
US

V. Phone/Fax

Practice location:
  • Phone: 804-837-2196
  • Fax:
Mailing address:
  • Phone: 804-837-2196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0001160918
License Number StateVA

VIII. Authorized Official

Name: MR. WILLIAM SIMON
Title or Position: PRESIDENT
Credential:
Phone: 804-837-2196