Provider Demographics
NPI:1689143612
Name:HIXSON SMILES
Entity Type:Organization
Organization Name:HIXSON SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-877-1368
Mailing Address - Street 1:4611 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5034
Mailing Address - Country:US
Mailing Address - Phone:423-877-1368
Mailing Address - Fax:423-870-1725
Practice Address - Street 1:4611 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5034
Practice Address - Country:US
Practice Address - Phone:423-877-1368
Practice Address - Fax:423-870-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty