Provider Demographics
NPI:1649609439
Name:SMILES DENTAL ALASKA, LLC
Entity type:Organization
Organization Name:SMILES DENTAL ALASKA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-468-0490
Mailing Address - Street 1:9138 ARLON ST STE B
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3876
Mailing Address - Country:US
Mailing Address - Phone:509-468-0490
Mailing Address - Fax:509-468-1814
Practice Address - Street 1:9138 ARLON ST STE B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3876
Practice Address - Country:US
Practice Address - Phone:360-636-1865
Practice Address - Fax:360-232-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD000099331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty