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General NPI Number Information
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NPI Number | 1780076653
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Entity Type | Organization
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Legal Business Name | SMILE STUDIO
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 1517 12TH AVE NE
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City | JAMESTOWN
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State | ND
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Zip | 58401-2703
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Country | US
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Telephone | 701-252-1212
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Fax | 701-252-1839
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Provider Business Mailing Address
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Address Line | 1517 12TH AVE NE
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City | JAMESTOWN
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State | ND
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Zip | 58401-2703
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Country | US
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Telephone | 701-252-1212
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Fax | 701-252-1839
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALISON FALLGATTER
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Credential | DDS, MS
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Telephone | 701-252-1212
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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 | 1915
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License Number State | ND
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