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General NPI Number Information
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NPI Number | 1104511823
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Entity Type | Organization
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Legal Business Name | KEEP ON SMILING PEDIATRIC AND GENERAL DENTISTRY PLLC
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 3451 GOODMAN RD E STE 122
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City | SOUTHAVEN
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State | MS
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Zip | 38672-9302
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Country | US
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Telephone | 662-892-8535
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Fax | 662-420-7317
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Provider Business Mailing Address
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Address Line | 3451 GOODMAN RD E STE 122
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City | SOUTHAVEN
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State | MS
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Zip | 38672-9302
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Country | US
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Telephone | 662-892-8535
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Fax | 662-420-7317
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Authorized Official
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Title or Position | ASSOCIATE
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Name | DR. TAMEKA KNIGHT
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Credential | DDS
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Telephone | 251-564-4365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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