| NPI | 1780130336 |
|---|---|
| Doing Business As | SMILES AT LAKEWOOD RANCH |
| Entity Type | Organization |
| Authorized Contact | KENDRA WALKER Credentialing Team Lead 217-540-8312 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2017-01-11 |