Provider Demographics
NPI:1144838970
Name:SUPERIOR SMILES, LLC
Entity type:Organization
Organization Name:SUPERIOR SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-418-2138
Mailing Address - Street 1:100 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-4314
Mailing Address - Country:US
Mailing Address - Phone:662-418-0459
Mailing Address - Fax:
Practice Address - Street 1:16690 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2750
Practice Address - Country:US
Practice Address - Phone:662-418-0459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental