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General NPI Number Information
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NPI Number | 1568533727
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD SMILES YOUTH DENTISTRY, LLC
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 376 COOLEY ST
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City | SPRINGFIELD
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State | MA
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Zip | 01128-1144
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Country | US
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Telephone | 413-796-1616
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Fax | 413-796-1617
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Provider Business Mailing Address
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Address Line | 16 ARCADE UNIT 198747
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City | NASHVILLE
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State | TN
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Zip | 37219-1994
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Country | US
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Telephone | 615-750-0343
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Fax | 615-986-1705
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Authorized Official
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Title or Position | MANAGER, LICENSING & CREDENTIALING
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Name | MRS. JENELL STUMP
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Credential |
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Telephone | 615-750-0343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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