Provider Demographics
NPI:1174605752
Name:ENDLESS SMILES DENTAL GROUP, L.L.C.
Entity type:Organization
Organization Name:ENDLESS SMILES DENTAL GROUP, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-836-6362
Mailing Address - Street 1:164 W TIOGA ST
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-1466
Mailing Address - Country:US
Mailing Address - Phone:570-836-6362
Mailing Address - Fax:
Practice Address - Street 1:164 W TIOGA ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1466
Practice Address - Country:US
Practice Address - Phone:570-836-6362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty