Provider Demographics
NPI:1023121423
Name:AMAZING SMILES PC
Entity type:Organization
Organization Name:AMAZING SMILES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-304-0034
Mailing Address - Street 1:PO BOX 72029
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30271-2029
Mailing Address - Country:US
Mailing Address - Phone:770-304-0034
Mailing Address - Fax:770-304-3439
Practice Address - Street 1:3229 HIGHWAY 34 E
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2195
Practice Address - Country:US
Practice Address - Phone:770-304-0034
Practice Address - Fax:770-304-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty