| Fabulous Smilesp.c. | |
|
1188 Ralph David Abernathy Blvd. Suite 101 Atlanta GA 30310 | |
| (678) 206-0199 | |
| (404) 529-4465 |
| Full Name | Fabulous Smilesp.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1188 Ralph David Abernathy Blvd. Suite 101, Atlanta, Georgia |
| Authorized Official Name and Position | Aldous Wilson (OWNER) |
| Authorized Official Contact | 6782060199 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fabulous Smilesp.c. 1188 Ralph David Abernathy Blvd. Suite 101 Atlanta GA 30310 Ph: (678) 206-0199 | Fabulous Smilesp.c. 1188 Ralph David Abernathy Blvd. Suite 101 Atlanta GA 30310 Ph: (678) 206-0199 |
| NPI Number | 1235302563 |
|---|---|
| Provider Enumeration Date | 04/08/2008 |
| Last Update Date | 04/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235302563 | NPI | - | NPPES |
| 00809025B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN011947 (Georgia) | Primary |
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