Provider Demographics
NPI:1477814929
Name:SMILE RIGHT FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SMILE RIGHT FAMILY DENTISTRY
Other - Org Name:NORTHSIDE DENTAL PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-671-1111
Mailing Address - Street 1:8329 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2810
Mailing Address - Country:US
Mailing Address - Phone:770-671-1111
Mailing Address - Fax:770-379-0992
Practice Address - Street 1:8329 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-2810
Practice Address - Country:US
Practice Address - Phone:770-671-1111
Practice Address - Fax:770-379-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000969713CMedicaid