Provider Demographics
NPI:1326281726
Name:HEART SMILES, LLC
Entity Type:Organization
Organization Name:HEART SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAUNDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-794-3391
Mailing Address - Street 1:6223 MT MORIAH RD EXT
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2741
Mailing Address - Country:US
Mailing Address - Phone:901-794-3391
Mailing Address - Fax:901-794-9706
Practice Address - Street 1:6223 MT MORIAH RD EXT
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2741
Practice Address - Country:US
Practice Address - Phone:901-794-3391
Practice Address - Fax:901-794-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN004455Medicaid