Provider Demographics
NPI:1770811713
Name:CAMP CREEK SMILES FAMILY DENTISTRY
Entity type:Organization
Organization Name:CAMP CREEK SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-344-7645
Mailing Address - Street 1:3890 REDWINE RD SW
Mailing Address - Street 2:STE 108
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5582
Mailing Address - Country:US
Mailing Address - Phone:404-344-7645
Mailing Address - Fax:404-696-2883
Practice Address - Street 1:3890 REDWINE RD SW
Practice Address - Street 2:STE 108
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5582
Practice Address - Country:US
Practice Address - Phone:404-344-7645
Practice Address - Fax:404-696-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental