Provider Demographics
NPI:1710304373
Name:SRR LLC
Entity Type:Organization
Organization Name:SRR LLC
Other - Org Name:SIMPLE SMILES RESTORATIVE AND COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HIRAL
Authorized Official - Middle Name:ANKUR
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:706-346-9516
Mailing Address - Street 1:114 MIRRAMONT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8213
Mailing Address - Country:US
Mailing Address - Phone:770-592-7000
Mailing Address - Fax:770-517-7403
Practice Address - Street 1:114 MIRRAMONT LAKE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8213
Practice Address - Country:US
Practice Address - Phone:770-592-7000
Practice Address - Fax:770-517-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALC201400002141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty