Organization
THE SMILE FACTORY MOBILE CLINIC LLC
Active
Other names
The Smile Factory Mobile Clinic LLC
Organization subpart
No
Provider details
NPI number
Authorized official
SHERONTA JOHNSON (OWNER)
(618) 606-7824
Entity
Organization
Contact information
Practice address
1040 CARLYLE AVE STE 2A, BELLEVILLE, IL 62221-5533
(618) 606-7824
Mailing address
1040 CARLYLE AVE STE 2A, BELLEVILLE, IL 62221-5533
(618) 606-7824
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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