Provider Demographics
NPI:1093431983
Name:STARKVILLE SMILES, P.A.
Entity Type:Organization
Organization Name:STARKVILLE SMILES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLFOLK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-323-3245
Mailing Address - Street 1:301 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2155
Mailing Address - Country:US
Mailing Address - Phone:662-323-3245
Mailing Address - Fax:662-323-6004
Practice Address - Street 1:301 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2155
Practice Address - Country:US
Practice Address - Phone:662-323-3245
Practice Address - Fax:662-323-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental