The Smile Factory Mobile Clinic LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

THE SMILE FACTORY MOBILE CLINIC LLC

Doing business as

The Smile Factory Mobile Clinic LLC

Practice address

1040 Carlyle Ave Ste 2a
Belleville, IL 62221-5533

Phone

(618) 606-7824

NPI assigned

Nov 27, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sheronta Johnson

Title

Owner

Phone

(618) 606-7824

Specialties & licenses 2

Addresses

Other names 1

• The Smile Factory Mobile Clinic LLC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1871369298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 CARLYLE AVE STE 2A",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622215533",
            "telephone_number": "618-606-7824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 CARLYLE AVE STE 2A",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622215533",
            "telephone_number": "618-606-7824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SMILE FACTORY MOBILE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-27",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SHERONTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-606-7824"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Smile Factory Mobile Clinic LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Belleville, IL
• Providers in Belleville, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.