MEDICARE: PURE SMILES OCEAN SPRINGS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1346102092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE SMILES OCEAN SPRINGS INC

Provider Business Mailing Address
First Line	:	2693 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3106
Country	:	US
Telephone Number	:	228-872-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2693 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3106
Country	:	US
Telephone Number	:	228-872-2000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. ANDREW MARTIN GILICH
Credential	:
Telephone Number	:	228-872-2000

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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