RESERVOIR SMILES DENTISTRY, PLLC (NPI# 1316458136) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1316458136 |
Entity Type | Organization |
Organization Name | RESERVOIR SMILES DENTISTRY, PLLC |
Practice Address |
1149 Old Fannin Rd Ste 26 Brandon MS 39047-9244 |
Practice Telephone | 6019927972 |
Practice Fax Number | 6019927975 |
Mailing Telephone | 6019927972 |
Mailing Fax Number | 6019927975 |
Enumeration Date | 2017-10-19 |
Last Update Date | 2017-10-19 |
Authorized Official Name | DR. AMYE LEE SHAMBURGER (OWNER) |
Authorized Official Telephone | 7697983909 |
Authorized Official Credential | DMD |
Is Organization Subpart | Y |
Parent Organization Name | HALL FAMILY DENTISTRY |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QD0000X |
Clinic/Center Specialization: Dental |
3421 | MS | Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MS | DR. AMYE L SHAMBURGER | 1376725754 | 01 |
Street Address |
1149 OLD FANNIN RD STE 26 |
City | BRANDON |
State | MS |
Zip Code | 39047-9244 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1396368783 | Siyuan Chen Kennedy | Counselor | 108 Sandstone Drive, Brandon, MS 39047 | 2020-05-20 |
1568019784 | Juarez Brown Emerson | Registered Nurse | 426 Pinebrook Circle, Brandon, MS 39047 | 2019-08-22 |
1649764127 | Specialty Diagnostics LLC | Family Medicine | 1149 Old Fannin Rd Ste 22, Brandon, MS 39047 | 2018-06-19 |
1528423035 | Kathlene Strangeman | Social Worker | 111 Lakeshore Dr Apt G403, Brandon, MS 39047 | 2015-12-28 |
1174935076 | Anthony Davis | Counselor | 198 Bellegrove Cir, Brandon, MS 39047 | 2014-05-27 |
1144659178 | Medical Foundation of Central Ms, Inc | Family Medicine | 1887 Spillway Rd., Brandon, MS 39047 | 2013-11-12 |
1437429941 | Picton Timothy Evans | Pharmacist | 150 B Cumberland Ed, Brandon, MS 39047 | 2012-01-01 |
1275828030 | Kathryn Audell Piburn | Nurse Practitioner | 1887 Spillway Rd Ste 140, Brandon, MS 39047 | 2011-06-09 |
1801930532 | Susanne Reynolds Moore | Dentist | 1149 Old Fannin Rd, Suite 26, Brandon, MS 39047 | 2007-02-16 |
1194898429 | Brookshire Grocery Company | Durable Medical Equipment & Medical Supplies | 143 Plaza Drive Ext, Attention Pharmacy Dept, Brandon, MS 39047 | 2006-11-16 |
Find all providers in zip 39047 |
Taxonomy Code | 261QD0000X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Dental |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982242111 | Lumina Dentalof Brandon, Pa | Clinic/Center | 225 Brandon Town Center Dr, Brandon, FL 33511-4728 | 2019-12-18 |
1083099600 | Skylight Dental Care Pllc | Clinic/Center | 117 N. Oakwood Avenue, Brandon, FL 33510 | 2015-07-24 |
1841617305 | Mobile Health Solutions Inc | Clinic/Center | 1700 W Government St Ste 203, Brandon, MS 39042-2423 | 2014-03-23 |
1578122172 | Vladimir A. Avril, Pllc | Clinic/Center | 3413 S Kings Ave Ste 200, Brandon, FL 33511-7780 | 2019-06-07 |
1770064388 | Brandon Family Dentistry | Clinic/Center | 5 Carver St, Brandon, VT 05733-1103 | 2018-08-22 |
1073057964 | Suncoast Community Health Centers, Inc | Clinic/Center | 313 S Lakewood Dr, Brandon, FL 33511-2815 | 2016-12-12 |
1013325265 | Bruce D. Waterman, Dmd,pa | Clinic/Center | 127 Kingsway Rd, Brandon, FL 33510-4601 | 2014-07-31 |
1902220320 | Bruce Waterman Dmd, Sleep Ez,pl | Clinic/Center | 127 Kingsway Rd, Brandon, FL 33510-4601 | 2014-02-05 |
1265779052 | Grants Ferry Family Dentistry | Clinic/Center | 1075 Lake Village Cir, Brandon, MS 39047-6743 | 2013-01-14 |
1164607552 | Family Health Care Clinic, Inc. | Clinic/Center | 1551 W Government St, Brandon, MS 39042 | 2008-01-03 |
Find all providers in BRANDON |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.