Provider Demographics
NPI:1003047499
Name:SMILES FOREVER SERVICES, LLC
Entity Type:Organization
Organization Name:SMILES FOREVER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:770-963-8255
Mailing Address - Street 1:2148 DULUTH HWY 120
Mailing Address - Street 2:ST. 101
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-963-3963
Mailing Address - Fax:770-963-2383
Practice Address - Street 1:2148 DULUTH HWY
Practice Address - Street 2:ST 101
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-963-3963
Practice Address - Fax:770-963-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty