Organization
MS ODP OXFORD ORTHODONTICS PLLC
Active
Other names
Rebel Smiles Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN SMITH (VP)
(470) 207-3264
Entity
Organization
Contact information
Practice address
2311 JACKSON AVE W STE 302, OXFORD, MS 38655-5751
(662) 612-0063
Mailing address
2300 LAKEVIEW PARKWAY STE. 250, ALPHARETTA, GA 30009-3954
(470) 207-3264
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
08/22/2024
Last updated
05/08/2025
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