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General NPI Number Information
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NPI Number | 1265119192
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Entity Type | Organization
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Legal Business Name | HIRAM DENTAL SMILES
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 1899 LAKE RD STE 220
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City | HIRAM
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State | GA
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Zip | 30141-2293
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Country | US
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Telephone | 470-666-2866
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Fax |
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Provider Business Mailing Address
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Address Line | 1899 LAKE RD STE 220
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City | HIRAM
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State | GA
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Zip | 30141-2293
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Country | US
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Telephone | 470-666-2866
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | PRAVEEN R GUDIPATI
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Credential | DMD
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Telephone | 404-966-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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