Provider Demographics
NPI:1902667033
Name:SMILEVIBE DENTISTRY
Entity Type:Organization
Organization Name:SMILEVIBE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SURAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-609-2344
Mailing Address - Street 1:19221 108TH AVE SE SUITE 2
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-7369
Mailing Address - Country:US
Mailing Address - Phone:425-988-0801
Mailing Address - Fax:
Practice Address - Street 1:19221 108TH AVE SE SUITE 2
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-7369
Practice Address - Country:US
Practice Address - Phone:425-988-0801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental