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General NPI Number Information
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NPI Number | 1518142769
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Entity Type | Organization
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Legal Business Name | THE WINNING SMILE DENTAL GROUP LLC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 1350 W GOVERNMENT ST
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City | BRANDON
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State | MS
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Zip | 39042-3050
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Country | US
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Telephone | 601-825-3807
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Fax | 601-825-7507
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Provider Business Mailing Address
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Address Line | PO BOX 315
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City | BRANDON
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State | MS
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Zip | 39043-0315
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Country | US
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Telephone | 601-825-3807
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Fax | 601-825-7507
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HOWARD MARK STEVENS
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Credential | DDS
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Telephone | 601-825-3807
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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 | 1813-78
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License Number State | MS
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