Provider Demographics
NPI:1720383805
Name:VIVID SMILE DENTAL CENTER
Entity Type:Organization
Organization Name:VIVID SMILE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-202-2398
Mailing Address - Street 1:1177 GARDEN WALK BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-6245
Mailing Address - Country:US
Mailing Address - Phone:770-997-9090
Mailing Address - Fax:
Practice Address - Street 1:1177 GARDEN WALK BLVD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-6245
Practice Address - Country:US
Practice Address - Phone:770-997-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty