Provider Demographics
NPI:1376775510
Name:DR. DAVID M. VIETH 2, PC
Entity Type:Organization
Organization Name:DR. DAVID M. VIETH 2, PC
Other - Org Name:KOOL SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:VIETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-916-5036
Mailing Address - Street 1:210 INTERSTATE NORTH PKWY SE STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2233
Mailing Address - Country:US
Mailing Address - Phone:770-916-5028
Mailing Address - Fax:
Practice Address - Street 1:7839 EASTERN AVENUE STE 7842
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2116
Practice Address - Country:US
Practice Address - Phone:800-920-9947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty