Provider Demographics
NPI:1477962942
Name:SNELLVILLE SMILES DENTISTRY, PC
Entity Type:Organization
Organization Name:SNELLVILLE SMILES DENTISTRY, PC
Other - Org Name:SNELLVILLE SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISIOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIZOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-844-9454
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:1830 SCENIC HWY S, SUITE 210
Practice Address - Street 2:
Practice Address - City:SNELVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-844-9454
Practice Address - Fax:770-844-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty