Provider Demographics
NPI:1245954619
Name:GROUP ONE SMILES PLLC
Entity type:Organization
Organization Name:GROUP ONE SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-909-5459
Mailing Address - Street 1:549 SEAL PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1817
Mailing Address - Country:US
Mailing Address - Phone:617-909-5459
Mailing Address - Fax:
Practice Address - Street 1:210 HUMPHREY ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-1665
Practice Address - Country:US
Practice Address - Phone:617-909-5459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty