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General NPI Number Information
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NPI Number | 1538464524
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Entity Type | Organization
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Legal Business Name | SMASHING SMILES, PLLC
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 2021 K ST NW SUITE 820
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City | WASHINGTON
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State | DC
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Zip | 20006-1003
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Country | US
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Telephone | 202-828-9110
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Fax | 202-828-8366
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Provider Business Mailing Address
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Address Line | 2021 K ST NW SUITE 820
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City | WASHINGTON
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State | DC
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Zip | 20006-1003
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Country | US
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Telephone | 202-828-9110
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Fax | 202-828-8366
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALLENA WILLIS KENNERLY
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Credential | DMD
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Telephone | 571-278-3680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DEN10000484
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License Number State | DC
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