=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437352986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SMILE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2007
-----------------------------------------------------
Last Update Date | 06/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2205 CLINTON HWY
-----------------------------------------------------
City | POWELL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37849-7606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-945-5552
-----------------------------------------------------
Fax | 865-945-5552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2205 CLINTON HWY
-----------------------------------------------------
City | POWELL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37849-7606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-945-5552
-----------------------------------------------------
Fax | 865-945-5554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF CORPORATION
-----------------------------------------------------
Name | DR. F DON FOSTER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 865-945-5552
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS3810
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------