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General NPI Number Information
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NPI Number | 1376110460
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Entity Type | Organization
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Legal Business Name | KLEAN SONRISAS DENTAL CARE
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 3195 BUFORD HWY STE 3
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City | DULUTH
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State | GA
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Zip | 30096-3379
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Country | US
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Telephone | 678-768-1198
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Fax |
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Provider Business Mailing Address
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Address Line | 3195 BUFORD HWY STE 3
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City | DULUTH
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State | GA
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Zip | 30096-3379
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Country | US
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Telephone | 678-768-1198
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | VIVIANA SUAREZ
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Credential |
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Telephone | 678-768-1198
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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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