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General NPI Number Information
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NPI Number | 1912753583
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Entity Type | Organization
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Legal Business Name | T SMILE ORTHODONTICS, LLC
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 33790 BAINBRIDGE RD STE 211
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City | SOLON
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State | OH
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Zip | 44139-2982
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Country | US
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Telephone | 440-498-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 33790 BAINBRIDGE RD STE 211
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City | SOLON
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State | OH
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Zip | 44139-2982
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Country | US
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Telephone | 440-498-1155
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LIZ BRISLEY
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Credential |
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Telephone | 440-265-0627
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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 |
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License Number State |
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