Healthcare Provider Details

I. General information

NPI: 1972232080
Provider Name (Legal Business Name): DOWNEAST SMILE COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 JOE FRANK HARRIS PKWY SE STE B
CARTERSVILLE GA
30120-2430
US

IV. Provider business mailing address

791 JOE FRANK HARRIS PKWY SE STE B
CARTERSVILLE GA
30120-2430
US

V. Phone/Fax

Practice location:
  • Phone: 470-274-2828
  • Fax:
Mailing address:
  • Phone: 470-274-2828
  • Fax: 470-274-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OLIVIA MERANDI
Title or Position: OWNER
Credential: DDS
Phone: 470-274-2828