Provider Demographics
NPI:1659093250
Name:HEALTHY SMILES FAMILY DENTISTRY OF PASCAGOULA
Entity Type:Organization
Organization Name:HEALTHY SMILES FAMILY DENTISTRY OF PASCAGOULA
Other - Org Name:HEALTHY SMILES PASCAGOULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KINYATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:228-696-2611
Mailing Address - Street 1:3804 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-4167
Mailing Address - Country:US
Mailing Address - Phone:228-696-2611
Mailing Address - Fax:228-696-2675
Practice Address - Street 1:3804 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-4167
Practice Address - Country:US
Practice Address - Phone:228-696-2611
Practice Address - Fax:228-696-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty