SMILES ON BROADWAY DENTAL CARE (NPI# 1942608112) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942608112 |
| Entity Type | Organization |
| Organization Name | SMILES ON BROADWAY DENTAL CARE |
| Practice Address |
5442 Watkins Dr Jackson MS 39206-2034 |
| Practice Telephone | 6016654996 |
| Practice Fax Number | 6013980450 |
| Mailing Telephone | 6016654996 |
| Mailing Fax Number | 6013980450 |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2014-12-19 |
| Authorized Official Name | DR. LAMONICA DAVIS (PEDIATRIC DENTIST) |
| Authorized Official Telephone | 6016654996 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
PEDO-483-14 | MS | Dental Providers |
| Street Address |
5442 WATKINS DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39206-2034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477758548 | Gerald Clive Vincent | Dentist | 5442 Watkins Dr, Jackson, MS 39206 | 2007-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023661824 | Latoya Lanette Trunell | Occupational Therapy Assistant | 787 East Northside Drive, Jackson, MS 39206 | 2019-07-20 |
| 1649839291 | Andrew Harris | Dentist | 4505 I-55 Frontage Rd. N, Jackson, MS 39206 | 2019-06-07 |
| 1679065916 | Savannah Lee Zachry | Physical Therapist | 5140 Galaxie Dr Ste 108, Jackson, MS 39206 | 2018-06-02 |
| 1669987723 | Harmony House Calls LLC | Nurse Practitioner | 5140 Galaxie Dr Ste 105, Jackson, MS 39206 | 2017-12-11 |
| 1841719903 | Yolanda Yvette Bell | Nurse Practitioner | 6064 Whitestone Rd, Jackson, MS 39206 | 2017-09-10 |
| 1760907117 | Anthony Brown Jr. | Physical Therapist | 5411 I-55 North, Jackson, MS 39206 | 2017-08-07 |
| 1114457132 | Ambric N Williams | Occupational Therapy Assistant | 6017 Whitestone Rd, Jackson, MS 39206 | 2017-06-13 |
| 1952835613 | Peak Chiropractic Care, LLC | Chiropractor | 4915 I-55 North, Suite 201b, Jackson, MS 39206 | 2017-04-19 |
| 1447798293 | Peterkin and Associates of Mississippi Inc | Community/Behavioral Health | 5155 Galaxie Drive, Suite F, Jackson, MS 39206 | 2017-02-01 |
| 1952844219 | Jennifer Penick | Counselor | 460 Briarwood Drive, Suite 510, Jackson, MS 39206 | 2016-11-18 |
| Find all providers in zip 39206 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740673797 | Emilee Peeples Milling | Dentist | 1855 Crane Ridge Dr Ste 2, Jackson, MS 39216-4944 | 2015-03-16 |
| 1093108243 | Joseph Davis | Dentist | 2064 W County Line Rd, Jackson, NJ 08527 | 2015-03-12 |
| 1639472673 | Wild Smiles Pediatric Dentistry LLC | Dentist | 1189 Vann Drive, Jackson, TN 38305 | 2010-12-14 |
| 1710109012 | Jennifer Warren Mccarter | Dentist | 206 Murray Guard Dr, Jackson, TN 38305 | 2007-05-03 |
| 1790903607 | Thomas Charles Pink | Dentist | 2500 Spring Arbor Rd, Jackson, MI 49203 | 2007-04-23 |
| 1114045515 | Steven Lowell Davenport | Dentist | 2500 Spring Arbor Road, Jackson, MI 49203 | 2007-03-26 |
| 1760517544 | Livy Lee Cope | Dentist | 5315 Highway 18 W, Jackson, MS 39209-9421 | 2007-02-22 |
| 1164579504 | Teresa Mixon Perkins | Dentist | 5550 Ridgewood Rd Ste A, Jackson, MS 39211-4024 | 2007-01-05 |
| 1528152394 | West Tennessee Pediatric Dental Group Inc | Dentist | 206 Murray Guard Drive, Jackson, TN 38305 | 2006-10-03 |
| 1609974757 | Wilhelmina Fouche O'reilly | Dentist | 514f E Woodrow Wilson Ave, Jackson, MS 39216-4538 | 2006-09-20 |
| Find all providers in JACKSON | ||||
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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.