Provider Demographics
NPI:1962683532
Name:THE SMILE CENTER INC
Entity Type:Organization
Organization Name:THE SMILE CENTER INC
Other - Org Name:THE SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:662-417-2786
Mailing Address - Street 1:PO BOX 1199
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38902-1199
Mailing Address - Country:US
Mailing Address - Phone:662-417-2786
Mailing Address - Fax:
Practice Address - Street 1:2376 SUNSET DR
Practice Address - Street 2:SUITE B
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-2827
Practice Address - Country:US
Practice Address - Phone:662-417-2786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty