| One Smile Away Inc | |
|
4159 Elders Dr Augusta GA 30909-9145 | |
| (706) 231-0170 | |
| Not Available |
| Full Name | One Smile Away Inc |
|---|---|
| Speciality | Dentist |
| Location | 4159 Elders Dr, Augusta, Georgia |
| Authorized Official Name and Position | Tyjuan Marcquell Williams (OWNER) |
| Authorized Official Contact | 7062310170 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| One Smile Away Inc 4045 Jimmie Dyess Pkwy Augusta GA 30909-9491 Ph: (706) 231-0170 | One Smile Away Inc 4159 Elders Dr Augusta GA 30909-9145 Ph: (706) 231-0170 |
| NPI Number | 1558797761 |
|---|---|
| Provider Enumeration Date | 09/19/2013 |
| Last Update Date | 09/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558797761 | NPI | - | NPPES |
| 003107901A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN017325 (Georgia) | Primary |
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