Provider Demographics
NPI:1003365966
Name:SNOW WHITE SMILES, PC
Entity type:Organization
Organization Name:SNOW WHITE SMILES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-583-3090
Mailing Address - Street 1:454 LORIDANS DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4720 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:302
Practice Address - City:BERKELEY LAKE
Practice Address - State:GA
Practice Address - Zip Code:30071-5735
Practice Address - Country:US
Practice Address - Phone:404-583-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty