Provider Demographics
NPI:1982734596
Name:SMILES R US DENTAL CARE
Entity Type:Organization
Organization Name:SMILES R US DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-658-6112
Mailing Address - Street 1:407 W LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-2651
Mailing Address - Country:US
Mailing Address - Phone:731-658-6112
Mailing Address - Fax:731-658-6059
Practice Address - Street 1:407 W LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-2651
Practice Address - Country:US
Practice Address - Phone:731-658-6112
Practice Address - Fax:731-658-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN72631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN160348OtherDELTA DENTAL
TN4108150OtherBLUE CROSS BLUE SHIELD
TN16438Medicaid
PA1764104OtherUNITED CONCORDIA