Provider Demographics
NPI:1134899933
Name:HOMETOWN SMILES, PLLC
Entity type:Organization
Organization Name:HOMETOWN SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLERODE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-872-7179
Mailing Address - Street 1:8232 US HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1708
Mailing Address - Country:US
Mailing Address - Phone:901-872-7179
Mailing Address - Fax:901-872-7449
Practice Address - Street 1:8232 US HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1708
Practice Address - Country:US
Practice Address - Phone:901-872-7179
Practice Address - Fax:901-872-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ068518Medicaid