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General NPI Number Information
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NPI Number | 1740779792
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Entity Type | Organization
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Legal Business Name | SMILE DOCTORS OF OHIO, INC.
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Dates
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Enumeration Date | 05/05/2018
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Last Update Date | 05/05/2018
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Provider Practice Location Address
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Address Line | 10220 SAWMILL PKWY
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City | POWELL
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State | OH
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Zip | 43065-9189
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Country | US
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Telephone | 614-761-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 10220 SAWMILL PKWY
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City | POWELL
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State | OH
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Zip | 43065-9189
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Country | US
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Telephone | 614-761-9777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DALLAS H MARGESON
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Credential | DMD
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Telephone | 614-761-9777
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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 | 30.025199
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License Number State | OH
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