Provider Demographics
NPI:1528336344
Name:SMILE SHOPPES JEFFREY D RHODES DDS MS PLLC
Entity type:Organization
Organization Name:SMILE SHOPPES JEFFREY D RHODES DDS MS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:479-236-5333
Mailing Address - Street 1:5518 WALSH LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8947
Mailing Address - Country:US
Mailing Address - Phone:479-236-5333
Mailing Address - Fax:
Practice Address - Street 1:7058 W SUNSET AVE
Practice Address - Street 2:SUITE 9B
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0680
Practice Address - Country:US
Practice Address - Phone:479-756-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR29241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR191365631Medicaid