Provider Demographics
NPI:1689194623
Name:PHILIP B VICKERY FREDERICK L JONES JR DBA THE SMILE CENTER
Entity Type:Organization
Organization Name:PHILIP B VICKERY FREDERICK L JONES JR DBA THE SMILE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-672-3774
Mailing Address - Street 1:2823 HWY 31 W SOUTH
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188
Mailing Address - Country:US
Mailing Address - Phone:615-672-3774
Mailing Address - Fax:615-672-9630
Practice Address - Street 1:2823 HWY 31 W SOUTH
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188
Practice Address - Country:US
Practice Address - Phone:615-672-3774
Practice Address - Fax:615-672-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3220122300000X
TN7779122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty