Provider Demographics
NPI:1902991425
Name:SMILES4KIDS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:SMILES4KIDS PEDIATRIC DENTISTRY
Other - Org Name:CINDY R. PONG, DDS & TRISHA R. MCNAMARA, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-771-5231
Mailing Address - Street 1:11350 SPRINGFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4202
Mailing Address - Country:US
Mailing Address - Phone:513-771-5231
Mailing Address - Fax:513-771-5109
Practice Address - Street 1:11350 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4202
Practice Address - Country:US
Practice Address - Phone:513-771-5231
Practice Address - Fax:513-771-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 30-202661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty