Organization
HEALTHY SMILES FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KINYATTA SHAUNTEL BENNETT D.M.D (MANAGER)
(228) 697-3010
Entity
Organization
Contact information
Practice address
13179 THREE RIVERS RD, GULFPORT, MS 39503-4944
(228) 697-3010
Mailing address
14346 LAKEWOOD CV, GULFPORT, MS 39503-5048
(228) 697-3010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
356410
MS
Other
Enumeration date
12/11/2014
Last updated
12/11/2014
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