MEDICARE: SMILE STUDIO OF BUFORD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1063164358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILE STUDIO OF BUFORD, LLC

Provider Business Mailing Address
First Line	:	2725 HAMILTON MILL RD STE 700
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-6010
Country	:	US
Telephone Number	:	678-528-0772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 HAMILTON MILL RD
Second Line	:	STE 700
City	:	BUFORD
State	:	GA
Zip	:	30519-6010
Country	:	US
Telephone Number	:	678-528-0772
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. OLUYEMI WORKMAN
Credential	:	DDS
Telephone Number	:	678-528-0772

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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