Provider Demographics
NPI:1437975018
Name:AMAZING SMILES
Entity type:Organization
Organization Name:AMAZING SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:JENNILEE
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-396-0054
Mailing Address - Street 1:5454 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7508
Mailing Address - Country:US
Mailing Address - Phone:318-396-0054
Mailing Address - Fax:
Practice Address - Street 1:5454 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7508
Practice Address - Country:US
Practice Address - Phone:318-396-0054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMAZING SMILES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment