Provider Demographics
NPI:1407128663
Name:SMILES FOR KIDS LLC
Entity Type:Organization
Organization Name:SMILES FOR KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:DESH
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-433-1317
Mailing Address - Street 1:5140 BEECHAM CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3390
Mailing Address - Country:US
Mailing Address - Phone:404-433-1317
Mailing Address - Fax:770-781-0204
Practice Address - Street 1:1240 BUFORD RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-2731
Practice Address - Country:US
Practice Address - Phone:770-781-0203
Practice Address - Fax:770-781-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN128061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA437813642MMedicaid