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NPI Code Detail

MEDICARE: KOOL SMILES SC-2, PC

MEDICARE: KOOL SMILES SC-2, PC
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
11223E0200XEndodontics
21223S0112XOral and Maxillofacial Surgery (Dentist)
31223P0221XPediatric Dentistry
41223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1952685810
Entity Type Code : Organization
Provider Name (Legal Business Name) : KOOL SMILES SC-2, PC
Provider Business Mailing Address
First Line : 1090 NORTHCHASE PKWY SE STE 150
Second Line :
City : MARIETTA
State : GA
Zip : 30067-6407
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2349 CHERRY RD
Second Line :
City : ROCK HILL
State : SC
Zip : 29732-3169
Country : US
Telephone Number : 800-920-9947
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DAVID VIETH
Credential : DDS
Telephone Number : 770-916-5028
Provider Enumeration Date : 10/10/2011
Last Update Date : 12/18/2014

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