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General NPI Number Information
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NPI Number | 1407235054
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Entity Type | Organization
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Legal Business Name | SMILEAWAY FAMILY DENTISTRY, PLC
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 694 N GERMANTOWN PKWY SUITE 50
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City | CORDOVA
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State | TN
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Zip | 38018-6284
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Country | US
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Telephone | 901-334-1900
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Fax | 901-334-1911
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Provider Business Mailing Address
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Address Line | 694 N GERMANTOWN PKWY SUITE 50
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City | CORDOVA
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State | TN
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Zip | 38018-6284
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Country | US
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Telephone | 901-334-1900
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Fax | 901-334-1911
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Authorized Official
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Title or Position | OWNER
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Name | DR. VEENA V AMMAL
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Credential | DDS
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Telephone | 901-334-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS0000007987
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License Number State | TN
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