Healthcare Provider Details

I. General information

NPI: 1912342122
Provider Name (Legal Business Name): HEALTHY SMILES OF EAST COBB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 JOHNSON FERRY RD
MARIETTA GA
30062-9110
US

IV. Provider business mailing address

1505 JOHNSON FERRY RD
MARIETTA GA
30062-9110
US

V. Phone/Fax

Practice location:
  • Phone: 770-973-9765
  • Fax:
Mailing address:
  • Phone: 770-973-9765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMAD HUSAN ALBZREH
Title or Position: DMD
Credential:
Phone: 770-973-9765