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General NPI Number Information
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NPI Number | 1538935374
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Entity Type | Organization
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Legal Business Name | SMILE LINE PLLC
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 6403 NE 117TH AVE STE 101
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City | VANCOUVER
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State | WA
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Zip | 98662-5518
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Country | US
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Telephone | 805-280-9942
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Fax |
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Provider Business Mailing Address
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Address Line | 4031 NW SIERRA DR
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City | CAMAS
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State | WA
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Zip | 98607-8518
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Country | US
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Telephone | 805-280-9942
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ADEL AM MRIHIL
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Credential |
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Telephone | 805-280-9942
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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 |
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License Number State |
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