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General NPI Number Information
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NPI Number | 1578955308
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL SMILES ORTHODONTICS, LLC
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 3695 CASCADE RD SW STE V
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City | ATLANTA
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State | GA
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Zip | 30331-2146
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Country | US
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Telephone | 404-696-1023
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Fax |
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Provider Business Mailing Address
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Address Line | 3695 CASCADE RD SW STE V
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City | ATLANTA
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State | GA
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Zip | 30331-2146
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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 | CEO
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Name | DR. PAUL MCKOY
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Credential |
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Telephone | 404-696-1023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN012765
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License Number State | GA
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