Provider Demographics
NPI:1104511823
Name:KEEP ON SMILING PEDIATRIC AND GENERAL DENTISTRY PLLC
Entity type:Organization
Organization Name:KEEP ON SMILING PEDIATRIC AND GENERAL DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-564-4365
Mailing Address - Street 1:3451 GOODMAN RD E STE 122
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-9302
Mailing Address - Country:US
Mailing Address - Phone:662-892-8535
Mailing Address - Fax:662-420-7317
Practice Address - Street 1:3451 GOODMAN RD E STE 122
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-9302
Practice Address - Country:US
Practice Address - Phone:662-892-8535
Practice Address - Fax:662-420-7317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty