Provider Demographics
NPI:1063811230
Name:EVERGROWING SMILES LLC
Entity type:Organization
Organization Name:EVERGROWING SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:E.
Authorized Official - Middle Name:A
Authorized Official - Last Name:STRANQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-206-9255
Mailing Address - Street 1:9 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3382
Mailing Address - Country:US
Mailing Address - Phone:856-206-9255
Mailing Address - Fax:856-206-9254
Practice Address - Street 1:9 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3382
Practice Address - Country:US
Practice Address - Phone:856-206-9255
Practice Address - Fax:856-206-9254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty