Provider Demographics
NPI:1134357833
Name:FOREVER SMILES, PLLC
Entity type:Organization
Organization Name:FOREVER SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNORR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-864-3129
Mailing Address - Street 1:2100 11TH ST E
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-2625
Mailing Address - Country:US
Mailing Address - Phone:320-864-3129
Mailing Address - Fax:320-500-6011
Practice Address - Street 1:2100 11TH ST E
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-2625
Practice Address - Country:US
Practice Address - Phone:320-864-3129
Practice Address - Fax:320-500-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty