| Reservoir Smiles Dentistry, Pllc | |
|
1149 Old Fannin Rd Ste 26 Brandon MS 39047-9244 | |
| (601) 992-7972 | |
| (601) 992-7975 |
| Full Name | Reservoir Smiles Dentistry, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1149 Old Fannin Rd Ste 26, Brandon, Mississippi |
| Authorized Official Name and Position | Amye Lee Shamburger (OWNER) |
| Authorized Official Contact | 7697983909 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Reservoir Smiles Dentistry, Pllc 1149 Old Fannin Rd Ste 26 Brandon MS 39047-9244 Ph: (601) 992-7972 | Reservoir Smiles Dentistry, Pllc 1149 Old Fannin Rd Ste 26 Brandon MS 39047-9244 Ph: (601) 992-7972 |
| NPI Number | 1316458136 |
|---|---|
| Provider Enumeration Date | 10/19/2017 |
| Last Update Date | 10/19/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316458136 | NPI | - | NPPES |
| 1376725754 | Other | MS | DR. AMYE L SHAMBURGER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 3421 (Mississippi) | Primary |
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