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General NPI Number Information
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NPI Number | 1649818840
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Entity Type | Organization
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Legal Business Name | SIMPLY SMILES, INC.
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 27249 HWY 212
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City | LA PLANT
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State | SD
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Zip | 57652
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Country | US
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Telephone | 32-810-4041
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Fax |
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Provider Business Mailing Address
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Address Line | 1771 POST RD E
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City | WESTPORT
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State | CT
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Zip | 06880-5606
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Country | US
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Telephone | 203-810-4041
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Fax |
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Authorized Official
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Title or Position | CLINICAL COORDINATOR
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Name | MR. COLTER COMBELLICK
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Credential | MSW, LICSW, CSW -PIP
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Telephone | 203-810-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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