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General NPI Number Information
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NPI Number | 1548584154
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Entity Type | Organization
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Legal Business Name | SMOKE RISE DENTAL
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 5500 LILBURN STONE MOUNTAIN RD STE A
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-2873
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Country | US
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Telephone | 770-923-5500
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Fax | 770-923-0044
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Provider Business Mailing Address
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Address Line | 5500 LILBURN STONE MOUNTAIN RD STE A
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-2873
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Country | US
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Telephone | 770-923-5500
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Fax | 770-923-0044
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Authorized Official
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Title or Position | DOCTOR
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Name | HASSAN A. ABDEL- MOETI
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Credential |
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Telephone | 770-923-5500
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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 | DN 013813
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License Number State | GA
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