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General NPI Number Information
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NPI Number | 1417287376
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Entity Type | Organization
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Legal Business Name | SMARTSMILE ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 12/28/2009
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 7724 OLD CANTON RD
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City | MADISON
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State | MS
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Zip | 39110-9299
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Country | US
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Telephone | 601-853-1307
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Fax | 601-853-9872
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Provider Business Mailing Address
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Address Line | 7724 OLD CANTON RD
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City | MADISON
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State | MS
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Zip | 39110-9299
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Country | US
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Telephone | 601-853-1307
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Fax | 601-853-9872
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ERIN BRITTON MONTGOMERY
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Credential | DMD, MSD
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Telephone | 601-853-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3388-06
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License Number State | MS
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