Provider Demographics
NPI:1245561638
Name:SMILE BY DESIGN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SMILE BY DESIGN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JESSE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-286-0233
Mailing Address - Street 1:1999 SAINT JOHN AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2117
Mailing Address - Country:US
Mailing Address - Phone:731-286-0233
Mailing Address - Fax:731-286-0021
Practice Address - Street 1:1999 SAINT JOHN AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2117
Practice Address - Country:US
Practice Address - Phone:731-286-0233
Practice Address - Fax:731-286-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty