Provider Demographics
NPI:1639856552
Name:PEACH SMILES
Entity Type:Organization
Organization Name:PEACH SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-966-7766
Mailing Address - Street 1:4825 SUGARLOAF PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8800
Mailing Address - Country:US
Mailing Address - Phone:770-609-6620
Mailing Address - Fax:
Practice Address - Street 1:4825 SUGARLOAF PKWY STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8800
Practice Address - Country:US
Practice Address - Phone:770-609-6620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty