Provider Demographics
NPI:1659826196
Name:SHINING SMILES FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SHINING SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILA
Authorized Official - Middle Name:MOHIP
Authorized Official - Last Name:CHAHWALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-469-3064
Mailing Address - Street 1:5041 DALLAS HWY BLDG 1E
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6424
Mailing Address - Country:US
Mailing Address - Phone:770-420-8550
Mailing Address - Fax:770-420-8544
Practice Address - Street 1:5041 DALLAS HWY BLDG 1E
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6424
Practice Address - Country:US
Practice Address - Phone:770-420-8550
Practice Address - Fax:770-420-8544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty