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General NPI Number Information
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NPI Number | 1174964530
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Entity Type | Organization
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Legal Business Name | SOUTH MISSISSIPPI SMILES DENTISTRY LLC
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 9350 HIGHWAY 49
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City | GULFPORT
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State | MS
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Zip | 39503-4213
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Country | US
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Telephone | 520-722-1182
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Fax | 520-798-2418
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Provider Business Mailing Address
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Address Line | 9354 HIGHWAY 49 STE L
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City | GULFPORT
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State | MS
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Zip | 39503-4226
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Country | US
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Telephone | 228-206-1234
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Fax | 228-206-2362
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | TERESA ZWICKY
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Credential |
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Telephone | 480-866-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 357110
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License Number State | MS
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