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General NPI Number Information
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NPI Number | 1891585998
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Entity Type | Organization
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Legal Business Name | SNELLVILLE DENTAL SMILES
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 2992 MAIN ST W STE A100
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City | SNELLVILLE
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State | GA
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Zip | 30078-5764
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Country | US
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Telephone | 770-972-1039
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 AZALEA BLUFF DR
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City | CUMMING
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State | GA
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Zip | 30041-3207
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Country | US
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Telephone | 404-966-7766
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRAVEEN R GUDIPATI
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Credential | DMD
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Telephone | 404-966-7766
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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 |
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License Number State |
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