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General NPI Number Information
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NPI Number | 1043617277
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Entity Type | Organization
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Legal Business Name | SMILES TO GO, LLC
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 214 CLAIBORNE ST
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City | LIBERTY
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State | MS
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Zip | 39645-8179
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Country | US
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Telephone | 601-551-2003
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Fax | 601-657-5889
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Provider Business Mailing Address
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Address Line | 214 CLAIBORNE ST
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City | LIBERTY
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State | MS
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Zip | 39645-8179
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Country | US
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Telephone | 601-551-2003
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Fax | 601-657-5889
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Authorized Official
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Title or Position | OWNER
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Name | SARAH ASHLEY CASEY
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Credential | BSN, MBA, MPH, NHA
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Telephone | 601-551-2003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3412-07
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License Number State | MS
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