Provider Demographics
NPI:1982258968
Name:SMILE WIT CONFIDENT, LLC
Entity Type:Organization
Organization Name:SMILE WIT CONFIDENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-629-6222
Mailing Address - Street 1:6465 TARA BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1214
Mailing Address - Country:US
Mailing Address - Phone:770-629-6222
Mailing Address - Fax:678-672-3131
Practice Address - Street 1:6465 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1214
Practice Address - Country:US
Practice Address - Phone:770-629-6222
Practice Address - Fax:678-672-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA052452435OtherDENTAL INSURANCE
GADN008017OtherDENTAL INSURANCE