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General NPI Number Information
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NPI Number | 1831447093
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Entity Type | Organization
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Legal Business Name | SMART SMILES DENTAL CARE LLC
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Dates
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Enumeration Date | 08/20/2012
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 1104 N SHORE DR
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City | CARLSBAD
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State | NM
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Zip | 88220-4638
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Country | US
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Telephone | 575-302-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 N SHORE DR
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City | CARLSBAD
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State | NM
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Zip | 88220-4638
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Country | US
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Telephone | 575-302-6677
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTAL HYGIENIST
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Name | MRS. PEGGY H HYDEN
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Credential | RDH
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Telephone | 575-302-6677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH535
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License Number State | NM
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