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General NPI Number Information
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NPI Number | 1528270733
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Entity Type | Organization
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Legal Business Name | SMILEBUILDERS INC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1863 HIGHWAY 43 S STE A
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City | CANTON
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State | MS
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Zip | 39046-8877
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Country | US
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Telephone | 601-859-7050
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Fax | 601-859-7062
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Provider Business Mailing Address
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Address Line | 1863 HIGHWAY 43 S STE A
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City | CANTON
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State | MS
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Zip | 39046-8877
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Country | US
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Telephone | 601-859-7050
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Fax | 601-859-7062
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Authorized Official
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Title or Position | CEO PRESIDENT
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Name | PRESTON L. COBBINS
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Credential | DDO
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Telephone | 601-859-7050
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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 | 3062-98
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License Number State | MS
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