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General NPI Number Information
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NPI Number | 1316581283
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Entity Type | Organization
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Legal Business Name | SMILE PARLOR LLC
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 2714 HIGHWAY 155
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City | LOCUST GROVE
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State | GA
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Zip | 30248-2401
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Country | US
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Telephone | 470-502-0820
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Fax | 470-502-0821
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Provider Business Mailing Address
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Address Line | 2714 HIGHWAY 155
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City | LOCUST GROVE
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State | GA
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Zip | 30248-2401
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Country | US
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Telephone | 470-502-0820
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Fax | 470-502-0821
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Authorized Official
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Title or Position | OWNER
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Name | DAVID MARCEL JENKINS
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Credential | DMD
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Telephone | 770-866-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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