Healthcare Provider Details

I. General information

NPI: 1548062995
Provider Name (Legal Business Name): HAPPY SMILES - OLIVE BRANCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 GOODMAN RD
OLIVE BRANCH MS
38654-1722
US

IV. Provider business mailing address

9880 GOODMAN RD
OLIVE BRANCH MS
38654-1722
US

V. Phone/Fax

Practice location:
  • Phone: 662-804-4262
  • Fax: 662-350-7106
Mailing address:
  • Phone: 662-804-4262
  • Fax: 662-350-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TERESA ZWICKY
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 480-866-8811