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General NPI Number Information
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NPI Number | 1659093250
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES FAMILY DENTISTRY OF PASCAGOULA
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 10/01/2022
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Provider Practice Location Address
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Address Line | 3804 HOSPITAL ST
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City | PASCAGOULA
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State | MS
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Zip | 39581-4167
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Country | US
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Telephone | 228-696-2611
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Fax | 228-696-2675
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Provider Business Mailing Address
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Address Line | 3804 HOSPITAL ST
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City | PASCAGOULA
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State | MS
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Zip | 39581-4167
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Country | US
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Telephone | 228-696-2611
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Fax | 228-696-2675
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Authorized Official
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Title or Position | OWNER
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Name | DR. KINYATTA BENNETT
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Credential | DMD
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Telephone | 228-696-2611
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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 |
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License Number State |
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