MEDICARE: BUCKHEAD SMILE CENTER, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1609170158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKHEAD SMILE CENTER, P.C.

Provider Business Mailing Address
First Line	:	2900 PEACHTREE RD NW
Second Line	:	SUITE 209
City	:	ATLANTA
State	:	GA
Zip	:	30305-4915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 PEACHTREE RD NW
Second Line	:	SUITE 209
City	:	ATLANTA
State	:	GA
Zip	:	30305-4915
Country	:	US
Telephone Number	:	404-261-0909
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	LORI SPENCE
Credential	:
Telephone Number	:	770-312-5167

Provider Enumeration Date	:	12/27/2010
Last Update Date	:	12/27/2010

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