Organization
MOUNTAIN SMILES - LONGVIEW DENTAL, PLLC
Active
Other names
Smiles Dental
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL GIMENEZ (CREDENTIALING SENIOR MANAGER)
(719) 300-5933
Entity
Organization
Contact information
Practice address
900 FIR ST STE 1D, LONGVIEW, WA 98632-2544
(360) 261-6094
(360) 577-0566
Mailing address
900 FIR ST STE 1D, LONGVIEW, WA 98632-2544
(360) 261-6094
(360) 577-0566
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223D0004X
Dental Anesthesiology
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
122400000X
Denturist
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
Other
Enumeration date
03/07/2025
Last updated
03/07/2025
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