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General NPI Number Information
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NPI Number | 1609298942
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Entity Type | Organization
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Legal Business Name | SMILE DENTURES, PLLC
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 3925 ABBEY LANE STE 7
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City | ASTORIA
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State | OR
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Zip | 97103-2235
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Country | US
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Telephone | 503-836-7711
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Fax | 951-888-8668
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Provider Business Mailing Address
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Address Line | 3925 ABBEY LANE STE 7
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City | ASTORIA
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State | OR
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Zip | 97103-2235
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Country | US
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Telephone | 503-836-7711
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Fax | 951-888-6684
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Authorized Official
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Title or Position | LICENSED DENTURIST
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Name | MISS ROBERT ARNOLD BECKNER II
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Credential | LD
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Telephone | 503-440-6540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | DT-DO-10157767
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License Number State | OR
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