| The Smile Studio PA | |
|
1029 Highway 51 Ste D Madison MS 39110-7648 | |
| (601) 605-2525 | |
| (601) 605-2524 |
| Full Name | The Smile Studio PA |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1029 Highway 51 Ste D, Madison, Mississippi |
| Authorized Official Name and Position | William O Rives (OWNER) |
| Authorized Official Contact | 6016052525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Smile Studio PA 1029 Highway 51 Ste D Madison MS 39110-7648 Ph: (601) 605-2525 | The Smile Studio PA 1029 Highway 51 Ste D Madison MS 39110-7648 Ph: (601) 605-2525 |
| NPI Number | 1861650368 |
|---|---|
| Provider Enumeration Date | 05/30/2008 |
| Last Update Date | 05/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861650368 | NPI | - | NPPES |
| 06684372 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 320701 (Mississippi) | Primary |
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