Healthcare Provider Details

I. General information

NPI: 1164633228
Provider Name (Legal Business Name): SMILES AND BLESSINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 LANE AVE JCM HIGH SCHOOL
JACKSON TN
38301-4577
US

IV. Provider business mailing address

332 LANE AVE JCM HIGH SCHOOL
JACKSON TN
38301-4577
US

V. Phone/Fax

Practice location:
  • Phone: 731-427-3351
  • Fax: 731-423-9711
Mailing address:
  • Phone: 731-427-3351
  • Fax: 731-423-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7773
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN MCLEMORE
Title or Position: DENTIST
Credential: DDS
Phone: 731-424-2651