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General NPI Number Information
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NPI Number | 1578000444
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Entity Type | Organization
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Legal Business Name | ENGINEERED SMILES, LLC
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 670 JOHNSON FERRY RD
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City | MARIETTA
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State | GA
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Zip | 30068-4627
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Country | US
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Telephone | 678-801-6700
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Fax | 678-903-2428
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Provider Business Mailing Address
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Address Line | 670 JOHNSON FERRY RD
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City | MARIETTA
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State | GA
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Zip | 30068-4627
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Country | US
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Telephone | 678-801-6700
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Fax | 678-903-2428
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. DAVID WANG
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Credential | DMD
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Telephone | 678-801-6700
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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 | DN013957
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License Number State | GA
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