Provider Demographics
NPI:1760237283
Name:SMILE FOR US DENTISTRY PLLC
Entity Type:Organization
Organization Name:SMILE FOR US DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CORNELL
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-276-7314
Mailing Address - Street 1:1331 UNION AVE STE 1225
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7551
Mailing Address - Country:US
Mailing Address - Phone:901-276-7314
Mailing Address - Fax:901-276-6028
Practice Address - Street 1:1331 UNION AVE STE 1225
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7551
Practice Address - Country:US
Practice Address - Phone:901-276-7314
Practice Address - Fax:901-276-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty