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General NPI Number Information
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NPI Number | 1295992055
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Entity Type | Organization
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Legal Business Name | SUPER SMILES PC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 2058 N DECATUR RD
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City | DECATUR
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State | GA
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Zip | 30033-5306
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Country | US
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Telephone | 404-636-1200
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Fax | 404-636-1199
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Provider Business Mailing Address
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Address Line | 2058 N DECATUR RD
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City | DECATUR
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State | GA
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Zip | 30033-5306
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Country | US
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Telephone | 404-636-1200
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Fax | 404-636-1199
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. FRANCIS P SHAEFFER
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Credential | D.M.D
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Telephone | 404-636-1200
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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 | 012746
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License Number State | GA
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