Healthcare Provider Details

I. General information

NPI: 1033036298
Provider Name (Legal Business Name): PLUSH SMILE TEETH WHITENING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4982 BRAMBLEWOOD CIR
SUGAR HILL GA
30518-3193
US

IV. Provider business mailing address

4982 BRAMBLEWOOD CIR
SUGAR HILL GA
30518-3193
US

V. Phone/Fax

Practice location:
  • Phone: 770-375-7858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: LATOYA DRAYTON
Title or Position: REGISTERED DENTAL HYGIENIST
Credential: RDH
Phone: 770-375-7858