Provider Demographics
NPI:1609392075
Name:MCMINNVILLE SMILES, PLLC
Entity Type:Organization
Organization Name:MCMINNVILLE SMILES, PLLC
Other - Org Name:DENNIS K. JETER, D.D.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:DALLAS
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-728-4143
Mailing Address - Street 1:1056 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2454
Mailing Address - Country:US
Mailing Address - Phone:931-728-4143
Mailing Address - Fax:
Practice Address - Street 1:100 MORRISON ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2420
Practice Address - Country:US
Practice Address - Phone:931-473-8506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty