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General NPI Number Information
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NPI Number | 1891173449
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Entity Type | Organization
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Legal Business Name | MILES FOR SMILES, LLC
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 610 TEXAS ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-3554
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Country | US
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Telephone | 318-317-2800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 78505
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City | SHREVEPORT
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State | LA
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Zip | 71137-8505
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Country | US
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Telephone | 318-317-2800
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Fax |
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | ASHLEY MCCLENATHEN
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Credential |
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Telephone | 318-317-2800
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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 |
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License Number State |
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