Provider Demographics
NPI:1043617277
Name:SMILES TO GO, LLC
Entity Type:Organization
Organization Name:SMILES TO GO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MBA, MPH, NHA
Authorized Official - Phone:601-551-2003
Mailing Address - Street 1:214 CLAIBORNE ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-8179
Mailing Address - Country:US
Mailing Address - Phone:601-551-2003
Mailing Address - Fax:601-657-5889
Practice Address - Street 1:214 CLAIBORNE ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645-8179
Practice Address - Country:US
Practice Address - Phone:601-551-2003
Practice Address - Fax:601-657-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3412-07122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1730387655Medicaid