Healthcare Provider Details

I. General information

NPI: 1932036845
Provider Name (Legal Business Name): IJ DENTAL SMILE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E WALNUT AVE STE 9
DALTON GA
30721-4171
US

IV. Provider business mailing address

1100 E WALNUT AVE STE 9
DALTON GA
30721-4171
US

V. Phone/Fax

Practice location:
  • Phone: 706-508-4222
  • Fax:
Mailing address:
  • Phone: 706-508-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MANOJ KUMAR
Title or Position: OWNER
Credential: DDS
Phone: 706-508-4222