Provider Demographics
NPI:1407235054
Name:SMILEAWAY FAMILY DENTISTRY, PLC
Entity Type:Organization
Organization Name:SMILEAWAY FAMILY DENTISTRY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VEENA
Authorized Official - Middle Name:V
Authorized Official - Last Name:AMMAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-334-1900
Mailing Address - Street 1:694 N GERMANTOWN PKWY
Mailing Address - Street 2:SUITE 50
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6284
Mailing Address - Country:US
Mailing Address - Phone:901-334-1900
Mailing Address - Fax:901-334-1911
Practice Address - Street 1:694 N GERMANTOWN PKWY
Practice Address - Street 2:SUITE 50
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6284
Practice Address - Country:US
Practice Address - Phone:901-334-1900
Practice Address - Fax:901-334-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000007987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty