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Organization
SMILES R US DENTAL CARE
Active
Organization
SMILES R US DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANITA JO PARKS D.D.S. (DENTIST)
(731) 658-6112
Entity
Organization
Contact information
Practice address
407 W LAFAYETTE ST, BOLIVAR, TN 38008-2651
(731) 658-6112
(731) 658-6059
Mailing address
407 W LAFAYETTE ST, BOLIVAR, TN 38008-2651
(731) 658-6112
(731) 658-6059
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7263
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160348
DELTA DENTAL
TN
05
—
16438
—
TN
01
—
1764104
UNITED CONCORDIA
PA
01
—
4108150
BLUE CROSS BLUE SHIELD
TN
Enumeration date
03/06/2007
Last updated
08/22/2020
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