Provider Demographics
NPI:1255734174
Name:CONYERS SMILES DENTISTRY, PC
Entity type:Organization
Organization Name:CONYERS SMILES DENTISTRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-921-3565
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:2239 HIGHWAY 20 SE
Practice Address - Street 2:SUITE H
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2091
Practice Address - Country:US
Practice Address - Phone:770-921-3565
Practice Address - Fax:770-921-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty