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General NPI Number Information
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NPI Number | 1457806317
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Entity Type | Organization
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Legal Business Name | SMART DENTAL CARE, LLC
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 34659 LA HIGHWAY 16
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City | DENHAM SPRINGS
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State | LA
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Zip | 70706-0667
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Country | US
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Telephone | 225-405-5066
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Fax | 225-677-9993
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Provider Business Mailing Address
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Address Line | 6234 RIVERINE DR
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City | BATON ROUGE
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State | LA
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Zip | 70820-5058
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Country | US
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Telephone | 225-405-5066
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Fax | 225-677-9993
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. JEREMY EMMETT MOORE
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Credential | D.D.S.
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Telephone | 225-405-5066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5491
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License Number State | LA
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