Provider Demographics
NPI:1467345942
Name:SMILE CENTER ORAL & MAXILLOFACIAL SURGERY, LLC
Entity type:Organization
Organization Name:SMILE CENTER ORAL & MAXILLOFACIAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-241-1010
Mailing Address - Street 1:700 WILDWOOD PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-3606
Mailing Address - Country:US
Mailing Address - Phone:229-241-1010
Mailing Address - Fax:507-428-6342
Practice Address - Street 1:700 WILDWOOD PLANTATION DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-3606
Practice Address - Country:US
Practice Address - Phone:229-241-1010
Practice Address - Fax:507-428-6342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty