| Ismile Family Dentistry | |
|
1305 Church Rd E Southaven MS 38671-9711 | |
| (662) 349-1141 | |
| (662) 349-6227 |
| Full Name | Ismile Family Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1305 Church Rd E, Southaven, Mississippi |
| Authorized Official Name and Position | Lashunda Thompson Roberts (PRESIDENT) |
| Authorized Official Contact | 6016221073 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ismile Family Dentistry Po Box 1168 Southaven MS 38671-0012 Ph: (662) 349-1141 | Ismile Family Dentistry 1305 Church Rd E Southaven MS 38671-9711 Ph: (662) 349-1141 |
| NPI Number | 1295402519 |
|---|---|
| Provider Enumeration Date | 08/25/2021 |
| Last Update Date | 08/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295402519 | NPI | - | NPPES |
| 09709245 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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