Healthcare Provider Details

I. General information

NPI: 1891942678
Provider Name (Legal Business Name): KISHA I. STEELE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 WISTERIA DR SUITE 300
SNELLVILLE GA
30078-2656
US

IV. Provider business mailing address

2220 WISTERIA DR SUITE 300
SNELLVILLE GA
30078-2656
US

V. Phone/Fax

Practice location:
  • Phone: 678-836-2107
  • Fax: 770-441-0299
Mailing address:
  • Phone: 678-836-2107
  • Fax: 770-441-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN013793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: