# DESIGNER SMILES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093589863
- **Authorized official:** DR. CHAD MICHAEL CLARK DDS (PRESIDENT)
- **Authorized official phone:** (307) 240-9966

## Contact information

- **Practice address:** 405 E 19TH ST, CHEYENNE, WY 82001-4643
- **Practice address phone:** (307) 343-5676
- **Mailing address:** 604 MEADOWLARK LN, RIVERTON, WY 82501-2214
- **Mailing address phone:** (307) 343-5676

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/13/2023
- **Last updated:** 12/01/2023