Provider Demographics
NPI:1144827767
Name:SMILERESTORE
Entity type:Organization
Organization Name:SMILERESTORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGENE
Authorized Official - Middle Name:BERNICE
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-800-1051
Mailing Address - Street 1:5365 MAE ANNE AVE STE B1
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-1897
Mailing Address - Country:US
Mailing Address - Phone:775-800-1051
Mailing Address - Fax:775-313-9032
Practice Address - Street 1:5365 MAE ANNE AVE STE B1
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-1897
Practice Address - Country:US
Practice Address - Phone:775-800-1051
Practice Address - Fax:775-313-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty