Provider Demographics
NPI:1538935374
Name:SMILE LINE PLLC
Entity type:Organization
Organization Name:SMILE LINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:AM
Authorized Official - Last Name:MRIHIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-280-9942
Mailing Address - Street 1:4031 NW SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8518
Mailing Address - Country:US
Mailing Address - Phone:805-280-9942
Mailing Address - Fax:
Practice Address - Street 1:6403 NE 117TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5518
Practice Address - Country:US
Practice Address - Phone:805-280-9942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental