Provider Demographics
NPI:1134658602
Name:SMILECARE PLLC
Entity Type:Organization
Organization Name:SMILECARE PLLC
Other - Org Name:FOREST METRO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GENTRI
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-469-8266
Mailing Address - Street 1:1237 HIGHWAY 35 S
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-8830
Mailing Address - Country:US
Mailing Address - Phone:601-469-8266
Mailing Address - Fax:601-469-8294
Practice Address - Street 1:1237 HIGHWAY 35 S
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-8830
Practice Address - Country:US
Practice Address - Phone:601-469-8266
Practice Address - Fax:601-469-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty