| The Smile Factory Mobile Clinic Llc | |
|
1040 Carlyle Ave Ste 2a Belleville IL 62221-5533 | |
| (618) 606-7824 | |
| Not Available |
| Full Name | The Smile Factory Mobile Clinic Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1040 Carlyle Ave Ste 2a, Belleville, Illinois |
| Authorized Official Name and Position | Sheronta Johnson (OWNER) |
| Authorized Official Contact | 6186067824 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Smile Factory Mobile Clinic Llc 1040 Carlyle Ave Ste 2a Belleville IL 62221-5533 Ph: (618) 606-7824 | The Smile Factory Mobile Clinic Llc 1040 Carlyle Ave Ste 2a Belleville IL 62221-5533 Ph: (618) 606-7824 |
| NPI Number | 1871369298 |
|---|---|
| Provider Enumeration Date | 11/27/2023 |
| Last Update Date | 11/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871369298 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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