Provider Demographics
NPI:1578900718
Name:SMILE DESIGNERS LLC
Entity Type:Organization
Organization Name:SMILE DESIGNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESUDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:DENYEL
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-649-4854
Mailing Address - Street 1:1709 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1802
Mailing Address - Country:US
Mailing Address - Phone:601-649-4854
Mailing Address - Fax:
Practice Address - Street 1:1709 W 20TH ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1802
Practice Address - Country:US
Practice Address - Phone:601-649-4854
Practice Address - Fax:601-651-6439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMILE DESIGNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS256990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02303099Medicaid
MS00060078Medicaid