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General NPI Number Information
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NPI Number | 1245561638
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Entity Type | Organization
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Legal Business Name | SMILE BY DESIGN FAMILY DENTISTRY
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 1999 SAINT JOHN AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-2117
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Country | US
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Telephone | 731-286-0233
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Fax | 731-286-0021
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Provider Business Mailing Address
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Address Line | 1999 SAINT JOHN AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-2117
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Country | US
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Telephone | 731-286-0233
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Fax | 731-286-0021
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Authorized Official
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Title or Position | OWNER/ DOCTOR
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Name | DR. RONALD JESSE REED
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Credential | DDS
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Telephone | 731-286-0233
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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 |
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License Number State |
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