Organization
RESERVOIR SMILES DENTISTRY, PLLC
Active
Parent organization
HALL FAMILY DENTISTRY
Organization subpart
Yes
Provider details
NPI number
Legal business name
HALL FAMILY DENTISTRY
Authorized official
DR. AMYE LEE SHAMBURGER DMD (OWNER)
(769) 798-3909
Entity
Organization
Contact information
Practice address
1149 OLD FANNIN RD STE 26, BRANDON, MS 39047-9244
(601) 992-7972
(601) 992-7975
Mailing address
1149 OLD FANNIN RD STE 26, BRANDON, MS 39047-9244
(601) 992-7972
(601) 992-7975
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3421
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376725754
DR. AMYE L SHAMBURGER
MS
Enumeration date
10/19/2017
Last updated
10/19/2017
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