1215721022 NPI number — PIEDMONT SMILES MOBILE DENTISTRY

Table of content: (NPI 1215721022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215721022 NPI number — PIEDMONT SMILES MOBILE DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT SMILES MOBILE DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215721022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKIN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28621-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-270-9157
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 YORKFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28621-9364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-366-0411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2025

Additional Information

Authorized Official

Authorized Official Last Name:
WILMOTH
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
GRACE SENTER
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
336-366-0411

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com