Provider Demographics
NPI:1700208642
Name:HEALTHY SMILES OF SAVANNAH
Entity Type:Organization
Organization Name:HEALTHY SMILES OF SAVANNAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:HAWKINS
Authorized Official - Last Name:HISSAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-777-5767
Mailing Address - Street 1:5420 PAULSEN STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-777-5767
Mailing Address - Fax:912-777-5773
Practice Address - Street 1:5420 PAULSEN STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-777-5767
Practice Address - Fax:912-777-5773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0134331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty