Provider Demographics
NPI:1821815465
Name:SWEET PEACH ORTHODONTICS, LLC
Entity type:Organization
Organization Name:SWEET PEACH ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAROLINA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:PELT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-575-3787
Mailing Address - Street 1:124 CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4351
Mailing Address - Country:US
Mailing Address - Phone:678-575-3787
Mailing Address - Fax:
Practice Address - Street 1:7824 HICKORY FLAT HWY STE 120
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6575
Practice Address - Country:US
Practice Address - Phone:404-383-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental