Healthcare Provider Details

I. General information

NPI: 1902725021
Provider Name (Legal Business Name): GEORGIA SMILE TEAM OF ALPHARETTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 MCGINNIS FERRY RD # 10A
ALPHARETTA GA
30005-3921
US

IV. Provider business mailing address

5230 MCGINNIS FERRY RD # 10A
ALPHARETTA GA
30005-3921
US

V. Phone/Fax

Practice location:
  • Phone: 678-527-1130
  • Fax: 770-643-2747
Mailing address:
  • Phone: 678-527-1130
  • Fax: 770-643-2747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: EUGENE WITKIN
Title or Position: OWNER
Credential: DDS
Phone: 678-527-1130