Provider Demographics
NPI:1548091135
Name:BLESSED SMILES
Entity type:Organization
Organization Name:BLESSED SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALISHA
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:HANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-503-1521
Mailing Address - Street 1:1151 MARGUERITE ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1881
Mailing Address - Country:US
Mailing Address - Phone:985-255-4524
Mailing Address - Fax:
Practice Address - Street 1:1151 MARGUERITE ST STE 100A
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1881
Practice Address - Country:US
Practice Address - Phone:985-255-4524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental