Healthcare Provider Details

I. General information

NPI: 1437530797
Provider Name (Legal Business Name): JMAC SMILES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 OXFORD RD
NEW ALBANY MS
38652-3115
US

IV. Provider business mailing address

212 OXFORD RD
NEW ALBANY MS
38652-3115
US

V. Phone/Fax

Practice location:
  • Phone: 662-534-8597
  • Fax: 662-538-0220
Mailing address:
  • Phone: 662-534-8597
  • Fax: 662-538-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3786-15
License Number StateMS

VIII. Authorized Official

Name: DR. JESSICA H. PERKINS
Title or Position: OWNER
Credential: DDS
Phone: 504-400-8897