Provider Demographics
NPI:1700126398
Name:SMILE MAGIC
Entity Type:Organization
Organization Name:SMILE MAGIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-480-3751
Mailing Address - Street 1:2880 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5051
Mailing Address - Country:US
Mailing Address - Phone:770-480-3751
Mailing Address - Fax:
Practice Address - Street 1:2880 OLD ALABAMA RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-5051
Practice Address - Country:US
Practice Address - Phone:770-480-3751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0124441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN012444OtherGEORGIA STATE DENTAL LICENSE
GADN012634OtherGEORGIA STATE DENTAL LICENSE