Provider Demographics
NPI:1689395337
Name:SEA OF PEARLS DENTISTRY LLC
Entity Type:Organization
Organization Name:SEA OF PEARLS DENTISTRY LLC
Other - Org Name:SEA OF PEARLS DENTAL BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:OLIVEIRA
Authorized Official - Last Name:LEMOINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:470-795-6677
Mailing Address - Street 1:1401 JOHNSON FERRY RD STE 164
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6499
Mailing Address - Country:US
Mailing Address - Phone:470-795-6677
Mailing Address - Fax:470-795-6678
Practice Address - Street 1:1401 JOHNSON FERRY RD STE 164
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6499
Practice Address - Country:US
Practice Address - Phone:470-795-6677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental