Healthcare Provider Details

I. General information

NPI: 1063164358
Provider Name (Legal Business Name): SMILE STUDIO OF BUFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 HAMILTON MILL RD STE 700
BUFORD GA
30519-6010
US

IV. Provider business mailing address

2725 HAMILTON MILL RD STE 700
BUFORD GA
30519-6010
US

V. Phone/Fax

Practice location:
  • Phone: 678-528-0772
  • Fax:
Mailing address:
  • Phone: 678-528-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUYEMI WORKMAN
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 678-528-0772