NPIMap

Organization Active NPI

Reservoir Smiles Dentistry, PLLC

  • Dental Clinic/Center
  • Brandon, MS
National Provider Identifier
1316458136
Registry record updated Oct 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
3421 Issued in MS
Legal business name
RESERVOIR SMILES DENTISTRY, PLLC
Practice address
1149 Old Fannin Rd Ste 26
Brandon, MS 39047-9244
Phone
(601) 992-7972
Fax
(601) 992-7975
NPI assigned
Oct 19, 2017
Organization subpart
Yes
Parent organization
HALL FAMILY DENTISTRYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2017

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

Authorized official

Name
Dr. Amye Lee Shamburger, DMD
Title
Owner
Phone
(769) 798-3909

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 3421 MS Primary

Addresses

Primary practice location

1149 Old Fannin Rd Ste 26
Brandon, MS 39047-9244

Mailing address

1149 Old Fannin Rd Ste 26
Brandon, MS 39047-9244
Phone (601) 992-7972

Other identifiers 1

IdentifierTypeStateIssuer
1376725754OtherMSDR. AMYE L SHAMBURGER

National Provider Directory

National Provider Directory
Part of
Hall Family Dentistry

Locations

1149 Old Fannin Rd
Ste 26
Brandon, MS 39047
Phone (601) 992-7972

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1508371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508371200000",
    "number": "1316458136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 OLD FANNIN RD STE 26",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390479244",
            "telephone_number": "601-992-7972",
            "fax_number": "601-992-7975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 OLD FANNIN RD STE 26",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390479244",
            "telephone_number": "601-992-7972",
            "fax_number": "601-992-7975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESERVOIR SMILES DENTISTRY, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HALL FAMILY DENTISTRY",
        "enumeration_date": "2017-10-19",
        "last_updated": "2017-10-19",
        "status": "A",
        "authorized_official_last_name": "SHAMBURGER",
        "authorized_official_first_name": "AMYE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "769-798-3909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MS",
            "license": "3421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. AMYE L SHAMBURGER",
            "identifier": "1376725754",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2017; 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.