| Smile Designers Llc | |
|
1709 W 20th St Laurel MS 39440-1802 | |
| (601) 649-4854 | |
| (601) 651-6439 |
| Full Name | Smile Designers Llc |
|---|---|
| Speciality | Dentist |
| Location | 1709 W 20th St, Laurel, Mississippi |
| Authorized Official Name and Position | Keisha Denyel Quinn (PRESUDENT) |
| Authorized Official Contact | 6016494854 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smile Designers Llc 1709 W 20th St Laurel MS 39440-1802 Ph: (601) 649-4854 | Smile Designers Llc 1709 W 20th St Laurel MS 39440-1802 Ph: (601) 649-4854 |
| NPI Number | 1578900718 |
|---|---|
| Provider Enumeration Date | 05/29/2013 |
| Last Update Date | 05/29/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578900718 | NPI | - | NPPES |
| 02303099 | Medicaid | MS | |
| 00060078 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 256990 (Mississippi) | Primary |
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