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General NPI Number Information
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NPI Number | 1386966059
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Entity Type | Organization
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Legal Business Name | SMILE TO SMILE FAMILY DENTAL & SEDATION CENTER, P.A.
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 429 S GOVERNORS AVE
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City | DOVER
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State | DE
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Zip | 19904-6707
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Country | US
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Telephone | 302-222-8106
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Fax | 302-736-0732
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Provider Business Mailing Address
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Address Line | 83 MERION RD
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City | DOVER
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State | DE
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Zip | 19904-2320
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Country | US
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Telephone | 302-222-8106
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Fax | 302-736-0732
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAWN M GRANDISON
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Credential | D.D.S.
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Telephone | 302-222-8106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | G4-0001201
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | G1-0001161
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License Number State | DE
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