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General NPI Number Information
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NPI Number | 1336893163
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Entity Type | Organization
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Legal Business Name | SIMPLE SMILES, P.C.
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 712 W WALNUT ST
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City | JOHNSON CITY
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State | TN
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Zip | 37604-6524
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Country | US
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Telephone | 423-218-0968
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Fax |
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Provider Business Mailing Address
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Address Line | 296 S MAIN ST STE 300
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City | ALPHARETTA
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State | GA
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Zip | 30009-1973
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | BEN CUTLER
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Credential |
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Telephone | 607-743-9474
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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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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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