Organization
SMILE COUNTRY ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CHELETTE (INSURANCE COORDINATOR)
(985) 893-1044
Entity
Organization
Contact information
Practice address
15465 OAK LN, GULFPORT, MS 39503-2663
(228) 832-4450
Mailing address
15465 OAK LN STE 100H, GULFPORT, MS 39503-2663
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3502-09
MS
Other
Enumeration date
06/29/2017
Last updated
06/29/2017
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