Provider Demographics
NPI:1689155202
Name:DR. SMILES PLLC A SERIES OF DR. SMILES OF MEMPHIS PLLC A TN SERIES LLC
Entity Type:Organization
Organization Name:DR. SMILES PLLC A SERIES OF DR. SMILES OF MEMPHIS PLLC A TN SERIES LLC
Other - Org Name:DR SMILES - KIRBY PKWY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARRIO
Authorized Official - Middle Name:RHODAN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-537-0077
Mailing Address - Street 1:670 COLONIAL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5160
Mailing Address - Country:US
Mailing Address - Phone:901-537-0077
Mailing Address - Fax:901-537-0088
Practice Address - Street 1:6621 KIRBY CENTER CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4313
Practice Address - Country:US
Practice Address - Phone:901-537-0077
Practice Address - Fax:901-537-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520914Medicaid