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General NPI Number Information
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NPI Number | 1275170987
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Entity Type | Organization
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Legal Business Name | PURE SMILES BILOXI, INC.
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 1764 PASS RD
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City | BILOXI
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State | MS
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Zip | 39531-3339
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Country | US
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Telephone | 228-374-5334
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Fax |
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Provider Business Mailing Address
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Address Line | 1764 PASS RD
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City | BILOXI
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State | MS
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Zip | 39531-3339
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Country | US
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Telephone | 228-374-5334
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. LAUREN MICHELLE BOLTON-GILICH
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Credential | DMD
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Telephone | 228-374-5334
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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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