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General NPI Number Information
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NPI Number | 1871299651
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Entity Type | Organization
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Legal Business Name | MINTYSMILE DENTISTRY
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Dates
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Enumeration Date | 02/03/2023
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 1428 BRENTWOOD DR
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City | MARIETTA
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State | GA
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Zip | 30062-2036
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Country | US
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Telephone | 404-903-6082
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Fax |
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Provider Business Mailing Address
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Address Line | 1428 BRENTWOOD DR
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City | MARIETTA
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State | GA
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Zip | 30062-2036
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Country | US
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Telephone | 404-903-6082
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | SELASSIE KUMAPLEY
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Credential |
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Telephone | 404-903-6082
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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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