Provider Demographics
NPI:1255843520
Name:RADIANT SMILES DENTAL OF CHAMBLEE LLC
Entity Type:Organization
Organization Name:RADIANT SMILES DENTAL OF CHAMBLEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:WU
Authorized Official - Last Name:MARHIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-455-1400
Mailing Address - Street 1:4306 N PEACHTREE RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4306 N PEACHTREE ROAD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30314
Practice Address - Country:US
Practice Address - Phone:770-455-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental