# SMALL SMILES OF MANASSAS, LLC

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

## Provider details

- **NPI number:** 1780718676
- **Authorized official:** MS. TRUDY WILLIAMS (DIRECTOR, LICENSING & CREDENTIALING)
- **Authorized official phone:** (615) 750-0342

## Contact information

- **Practice address:** 9012 MATHIS AVE, MANASSAS, VA 20110-5218
- **Practice address phone:** (571) 921-1111
- **Mailing address:** 201 W 8TH ST, SUITE 810, PUEBLO, CO 81003-3038
- **Mailing address phone:** (719) 562-4447

## Taxonomy

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

## Other

- **Enumeration date:** 03/15/2007
- **Last updated:** 05/17/2010