| Smiles On Broadway Dental Care | |
|
5442 Watkins Dr Jackson MS 39206-2034 | |
| (601) 665-4996 | |
| (601) 398-0450 |
| Full Name | Smiles On Broadway Dental Care |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 5442 Watkins Dr, Jackson, Mississippi |
| Authorized Official Name and Position | Lamonica Davis (PEDIATRIC DENTIST) |
| Authorized Official Contact | 6016654996 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smiles On Broadway Dental Care 5442 Watkins Dr Jackson MS 39206-2034 Ph: (601) 665-4996 | Smiles On Broadway Dental Care 5442 Watkins Dr Jackson MS 39206-2034 Ph: (601) 665-4996 |
| NPI Number | 1942608112 |
|---|---|
| Provider Enumeration Date | 12/19/2014 |
| Last Update Date | 12/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942608112 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | PEDO-483-14 (Mississippi) | Primary |
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