Provider Demographics
NPI:1659735801
Name:SOUTHERN SMILES DENTISTRY,LLC
Entity Type:Organization
Organization Name:SOUTHERN SMILES DENTISTRY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:BAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-446-4967
Mailing Address - Street 1:304 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1860
Mailing Address - Country:US
Mailing Address - Phone:615-446-4967
Mailing Address - Fax:615-446-8530
Practice Address - Street 1:304 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1860
Practice Address - Country:US
Practice Address - Phone:615-446-4967
Practice Address - Fax:615-446-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS46781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty