Provider Demographics
NPI:1780037846
Name:SMILES BY BIGELOW
Entity Type:Organization
Organization Name:SMILES BY BIGELOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIGELOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-582-1623
Mailing Address - Street 1:4301 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3036
Mailing Address - Country:US
Mailing Address - Phone:601-582-1623
Mailing Address - Fax:601-582-0765
Practice Address - Street 1:4301 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3036
Practice Address - Country:US
Practice Address - Phone:601-582-1623
Practice Address - Fax:601-582-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2759931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty