Healthcare Provider Details

I. General information

NPI: 1316856222
Provider Name (Legal Business Name): SHWSH-L, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 JILES RD NW STE 201
KENNESAW GA
30144-4613
US

IV. Provider business mailing address

3903 JILES RD NW STE 201
KENNESAW GA
30144-4613
US

V. Phone/Fax

Practice location:
  • Phone: 770-676-1317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILLIAM BRUCE FINK
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 770-331-1092