# ABOUT SMILES DENTAL, LLC

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

## Provider details

- **NPI number:** 1184061582
- **Authorized official:** DR. SVETLANA KONSTANTINOVNA SAMPSON DDS (OWNER)
- **Authorized official phone:** (214) 790-5151

## Contact information

- **Practice address:** 4575 23RD AVE S STE 1200, FARGO, ND 58104-8784
- **Practice address phone:** (701) 356-4077
- **Practice address fax:** (701) 356-2108
- **Mailing address:** 4575 23RD AVE S STE 1200, FARGO, ND 58104-8784
- **Mailing address phone:** (701) 356-4077
- **Mailing address fax:** (701) 356-2108

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 2105 | ND | Yes |

## Other

- **Enumeration date:** 05/27/2013
- **Last updated:** 05/28/2013