Provider Demographics
NPI:1427569664
Name:SOUTHEAST MOBILE SMILES
Entity Type:Organization
Organization Name:SOUTHEAST MOBILE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CALLIE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:FISHEL
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:865-441-2527
Mailing Address - Street 1:842 BROOKSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-6475
Mailing Address - Country:US
Mailing Address - Phone:865-441-2527
Mailing Address - Fax:
Practice Address - Street 1:842 BROOKSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6475
Practice Address - Country:US
Practice Address - Phone:865-441-2527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS98541223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty