MEDICARE: SMILES BY CRISP, PLLC

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	1223G0001X	General Practice Dentistry	2929	AR

General Provider Information

NPI Number	:	1992054167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILES BY CRISP, PLLC

Provider Business Mailing Address
First Line	:	9220 HIGHWAY 71 S
Second Line	:	SUITE A5
City	:	FORT SMITH
State	:	AR
Zip	:	72916-9117
Country	:	US
Telephone Number	:	479-646-1245
Fax Number	:	479-646-0592

Provider Business Practice Location Address
First Line	:	9220 HIGHWAY 71 S
Second Line	:	SUITE A5
City	:	FORT SMITH
State	:	AR
Zip	:	72916-9117
Country	:	US
Telephone Number	:	479-646-1245
Fax Number	:	479-646-0592

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MS. LUANNE MARIE DOWNEY
Credential	:
Telephone Number	:	405-570-5101

Provider Enumeration Date	:	09/04/2012
Last Update Date	:	09/04/2012

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