Organization
SMILES ON BROADWAY DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAMONICA DAVIS DMD (PEDIATRIC DENTIST)
(601) 665-4996
Entity
Organization
Contact information
Practice address
5442 WATKINS DR, JACKSON, MS 39206-2034
(601) 665-4996
(601) 398-0450
Mailing address
5442 WATKINS DR, JACKSON, MS 39206-2034
(601) 665-4996
(601) 398-0450
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
PEDO-483-14
MS
Other
Enumeration date
12/19/2014
Last updated
12/19/2014
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