Provider Demographics
NPI:1093146078
Name:MARIETTA SMILES LLC
Entity Type:Organization
Organization Name:MARIETTA SMILES LLC
Other - Org Name:JULIAN H. CAMPBELL CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-826-4233
Mailing Address - Street 1:175 WHITE ST NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1053
Mailing Address - Country:US
Mailing Address - Phone:770-422-6521
Mailing Address - Fax:770-422-6525
Practice Address - Street 1:175 WHITE ST NW
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1053
Practice Address - Country:US
Practice Address - Phone:770-422-6521
Practice Address - Fax:770-422-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN010592261QD0000X
GADN010102261QD0000X
GADN013011261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental