NPIMap

Organization Active NPI

Ismile Family Dentistry

  • Dental Clinic/Center
  • Southaven, MS
National Provider Identifier
1295402519
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
ISMILE FAMILY DENTISTRY
Doing business as
iSmile Family Dentistry
Practice address
1305 Church Rd E
Southaven, MS 38671-9711
Phone
(662) 349-1141
Fax
(662) 349-6227
NPI assigned
Aug 25, 2021
Last updated
Aug 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lashunda Thompson Roberts, DMDNPI 1740453240
Title
President
Phone
(601) 622-1073

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1305 Church Rd E
Southaven, MS 38671-9711

Mailing address

PO Box 1168
Southaven, MS 38671-0012
Phone (662) 349-1141

Other identifiers 1

IdentifierTypeStateIssuer
09709245MedicaidMS

Other names 1

  • iSmile Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1305 Church Rd E
Southaven, MS 38671
Phone (662) 349-1141

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1295402519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1168",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386710012",
            "telephone_number": "662-349-1141",
            "fax_number": "662-349-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 CHURCH RD E",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719711",
            "telephone_number": "662-349-1141",
            "fax_number": "662-349-6227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISMILE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-07-16",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "LASHUNDA",
        "authorized_official_middle_name": "THOMPSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-622-1073",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09709245",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "iSmile Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.