MEDICARE: SMILE DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1275143745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE DENTAL

Provider Business Mailing Address
First Line	:	28 BRANDERMILL DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-6600
Country	:	US
Telephone Number	:	702-994-6702
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 W HORIZON RIDGE PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-4896
Country	:	US
Telephone Number	:	702-994-6702
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIA L LE
Credential	:	DDS
Telephone Number	:	702-994-6702

Provider Enumeration Date	:	08/08/2020
Last Update Date	:	05/26/2021

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Directions to “SMILE DENTAL ” Practice Location

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