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General NPI Number Information
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NPI Number | 1033910567
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Entity Type | Organization
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Legal Business Name | SMILES ON WHEELS, LLC
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 2701 FREDERICK ST
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City | SHREVEPORT
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State | LA
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Zip | 71109-3607
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Country | US
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Telephone | 702-205-2623
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Fax |
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Provider Business Mailing Address
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Address Line | 11731 EMERALD LAKE AVE
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City | LAS VEGAS
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State | NV
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Zip | 89138-6403
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Country | US
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Telephone | 702-205-2623
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MICHAEL EVANS
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Credential |
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Telephone | 702-205-2623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 126900000X
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Taxonomy Name | Dental Laboratory Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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