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General NPI Number Information
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NPI Number | 1700126398
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Entity Type | Organization
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Legal Business Name | SMILE MAGIC
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 2880 OLD ALABAMA RD SUITE 400
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City | ALPHARETTA
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State | GA
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Zip | 30022-5051
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Country | US
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Telephone | 770-480-3751
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Fax |
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Provider Business Mailing Address
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Address Line | 2880 OLD ALABAMA RD SUITE 400
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City | ALPHARETTA
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State | GA
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Zip | 30022-5051
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Country | US
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Telephone | 770-480-3751
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEANNA MAGUIRE
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Credential |
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Telephone | 770-480-3751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN012444
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License Number State | GA
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