1932280237 NPI number — BEAUTIFUL SMILES FAMILY DENTISTRY, DDS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932280237 NPI number — BEAUTIFUL SMILES FAMILY DENTISTRY, DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAUTIFUL SMILES FAMILY DENTISTRY, DDS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932280237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 MALL PKWY
Provider Second Line Business Mailing Address:
SUITE #155
Provider Business Mailing Address City Name:
LITHONIA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30038-6983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-484-4051
Provider Business Mailing Address Fax Number:
770-484-4052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 MALL PKWY
Provider Second Line Business Practice Location Address:
SUITE #155
Provider Business Practice Location Address City Name:
LITHONIA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30038-6983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-484-4051
Provider Business Practice Location Address Fax Number:
770-484-4052
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DABNEY
Authorized Official First Name:
AMBER
Authorized Official Middle Name:
JENKINS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-484-4051

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com