Provider Demographics
NPI:1699118067
Name:GIGGLES & GRINS FAMILY DENTAL LLC
Entity type:Organization
Organization Name:GIGGLES & GRINS FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-367-4146
Mailing Address - Street 1:616 S LEWIS ST
Mailing Address - Street 2:STE J
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4826
Mailing Address - Country:US
Mailing Address - Phone:337-367-4746
Mailing Address - Fax:
Practice Address - Street 1:616 S LEWIS ST
Practice Address - Street 2:STE J
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4826
Practice Address - Country:US
Practice Address - Phone:337-367-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty