MEDICARE: SMYRNA DENTIST OFFICE, PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1841737376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMYRNA DENTIST OFFICE, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	2995 ATLANTA RD SE
Second Line	:	SUITE 200
City	:	SMYRNA
State	:	GA
Zip	:	30080-3654
Country	:	US
Telephone Number	:	678-203-3463
Fax Number	:	678-389-9027

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATIE L MCCANN
Credential	:	DDS
Telephone Number	:	678-203-3463

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/23/2017

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