Provider Demographics
NPI:1760745194
Name:DENTAL SMILES OF AMERICA LLC
Entity Type:Organization
Organization Name:DENTAL SMILES OF AMERICA LLC
Other - Org Name:DENTAL SMILES AT DACULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVANG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-495-9500
Mailing Address - Street 1:1325 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1121
Mailing Address - Country:US
Mailing Address - Phone:678-495-9500
Mailing Address - Fax:678-495-9501
Practice Address - Street 1:1325 AUBURN RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019
Practice Address - Country:US
Practice Address - Phone:678-495-9500
Practice Address - Fax:678-495-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013630261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental