# BIG SMILE DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902329329
- **Authorized official:** DR. CARTER M WALLER DMD (DENTIST)
- **Authorized official phone:** (540) 899-1777

## Contact information

- **Practice address:** 1315 JEFFERSON DAVIS HWY, FREDERICKSBURG, VA 22401-4640
- **Practice address phone:** (540) 899-1777
- **Practice address fax:** (540) 899-2266
- **Mailing address:** 1315 JEFFERSON DAVIS HWY, FREDERICKSBURG, VA 22401-4640
- **Mailing address phone:** (540) 899-1777
- **Mailing address fax:** (540) 899-2266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 0401410947 | VA | Yes |
| 261QD0000X | Dental Clinic/Center | 0401415285 | VA | — |

## Other

- **Enumeration date:** 07/18/2017
- **Last updated:** 07/21/2022