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General NPI Number Information
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NPI Number | 1255991196
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Entity Type | Organization
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Legal Business Name | SKY FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 200 MEADOWLANE STREET
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City | EUPORA
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State | MS
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Zip | 39744
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Country | US
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Telephone | 662-744-7040
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Fax | 662-744-7046
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Provider Business Mailing Address
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Address Line | 200 MEADOWLANE STREET
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City | EUPORA
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State | MS
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Zip | 39744
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Country | US
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Telephone | 662-744-7040
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Fax | 662-744-7046
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Authorized Official
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Title or Position | OWNER
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Name | DR. DUSTIN G. SMITH
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Credential | DMD
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Telephone | 601-297-9082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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