Provider Demographics
NPI:1245483882
Name:YOUR SMILE FAMILY DENTISTRY
Entity type:Organization
Organization Name:YOUR SMILE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-985-1050
Mailing Address - Street 1:3931 HWY 78
Mailing Address - Street 2:SUITE A
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-3930
Mailing Address - Country:US
Mailing Address - Phone:770-985-1050
Mailing Address - Fax:800-985-8967
Practice Address - Street 1:3931 HIGHWAY 78 W
Practice Address - Street 2:SUITE A
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-3930
Practice Address - Country:US
Practice Address - Phone:770-985-1050
Practice Address - Fax:800-985-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00581215AMedicaid