NPIMap

Organization Active NPI

Smile Design Orthodontics, LLC

  • Dentist
  • Hazlehurst, MS
National Provider Identifier
1891102604
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3651-12 Issued in MS
Legal business name
SMILE DESIGN ORTHODONTICS, LLC
Practice address
1047 W Gallman Rd
Hazlehurst, MS 39083-9452
Phone
(601) 955-7844
NPI assigned
Jul 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2014

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

Authorized official

Name
Dr. Chandra M. Minor, DMDNPI 1548690688
Title
Owner
Phone
(601) 955-7844

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 3651-12 MS Primary

Addresses

Primary practice location

1047 W Gallman Rd
Hazlehurst, MS 39083-9452

Mailing address

1047 W Gallman Rd
Hazlehurst, MS 39083-9452
Phone (601) 955-7844

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1405296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405296000000",
    "number": "1891102604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1047 W GALLMAN RD",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "390839452",
            "telephone_number": "601-955-7844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1047 W GALLMAN RD",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "390839452",
            "telephone_number": "601-955-7844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE DESIGN ORTHODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-14",
        "last_updated": "2014-07-14",
        "status": "A",
        "authorized_official_last_name": "MINOR",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-955-7844",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MS",
            "license": "3651-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazlehurst, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; 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.