Provider Demographics
NPI:1013718873
Name:SMYRNA DENTAL SMILES
Entity type:Organization
Organization Name:SMYRNA DENTAL SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-966-7766
Mailing Address - Street 1:2705 AZALEA BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-3207
Mailing Address - Country:US
Mailing Address - Phone:404-966-7766
Mailing Address - Fax:
Practice Address - Street 1:3240 S COBB DR SE STE 100
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4180
Practice Address - Country:US
Practice Address - Phone:770-801-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental