MEDICARE: SMILES BY DESIGN, INC.

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	122300000X	Dentist	30-02-0829	OH

General Provider Information

NPI Number	:	1386909901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILES BY DESIGN, INC.

Provider Business Mailing Address
First Line	:	8881 GOVERNORS HILL DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1337
Country	:	US
Telephone Number	:	513-697-7888
Fax Number	:	513-697-7908

Provider Business Practice Location Address
First Line	:	8881 GOVERNORS HILL DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-1337
Country	:	US
Telephone Number	:	513-697-7888
Fax Number	:	513-697-7908

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LALI S MINOCHA
Credential	:	DDS
Telephone Number	:	513-697-7888

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/10/2012

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