Provider Demographics
NPI:1376110460
Name:KLEAN SONRISAS DENTAL CARE
Entity Type:Organization
Organization Name:KLEAN SONRISAS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-768-1198
Mailing Address - Street 1:3195 BUFORD HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3379
Mailing Address - Country:US
Mailing Address - Phone:678-768-1198
Mailing Address - Fax:
Practice Address - Street 1:3195 BUFORD HWY STE 3
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3379
Practice Address - Country:US
Practice Address - Phone:678-768-1198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental