| Great Smile Dental | |
|
2145 Roswell Rd Ste 120 Marietta GA 30062-0821 | |
| (770) 565-1010 | |
| (770) 565-1037 |
| Full Name | Great Smile Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2145 Roswell Rd, Marietta, Georgia |
| Authorized Official Name and Position | Supriti Balyan (CEO) |
| Authorized Official Contact | 7705651010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Smile Dental 2145 Roswell Rd Ste 120 Marietta GA 30062-0821 Ph: (770) 565-1010 | Great Smile Dental 2145 Roswell Rd Ste 120 Marietta GA 30062-0821 Ph: (770) 565-1010 |
| NPI Number | 1457499642 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 03/29/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457499642 | NPI | - | NPPES |
| 350681612A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 011733 (Georgia) | Primary |
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