MEDICARE: DENTAL SMILES OF AMERICA LLC

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	261QD0000X	Dental Clinic/Center	DN013630	GA

General Provider Information

NPI Number	:	1760745194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SMILES OF AMERICA LLC

Provider Business Mailing Address
First Line	:	1325 AUBURN RD
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-1121
Country	:	US
Telephone Number	:	678-495-9500
Fax Number	:	678-495-9501

Provider Business Practice Location Address
First Line	:	1325 AUBURN RD
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019
Country	:	US
Telephone Number	:	678-495-9500
Fax Number	:	678-495-9501

Authorized Official
Title or Position	:	DENTIST/OWNER MEMBER
Name	:	DR. DEVANG SHAH
Credential	:	DMD
Telephone Number	:	678-495-9500

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	05/16/2016

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Directions to “DENTAL SMILES OF AMERICA LLC ” Practice Location

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