| Smoke Rise Dental | |
|
5500 Lilburn Stone Mountain Rd Ste A Stone Mountain GA 30087-2873 | |
| (770) 923-5500 | |
| (770) 559-9295 |
| Full Name | Smoke Rise Dental |
|---|---|
| Speciality | Dentist |
| Location | 5500 Lilburn Stone Mountain Rd Ste A, Stone Mountain, Georgia |
| Authorized Official Name and Position | Hassan Moeti (OWNER) |
| Authorized Official Contact | 7709235500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smoke Rise Dental 5500 Lilburn Stone Mountain Rd Ste A Stone Mountain GA 30087-2873 Ph: (770) 923-5500 | Smoke Rise Dental 5500 Lilburn Stone Mountain Rd Ste A Stone Mountain GA 30087-2873 Ph: (770) 923-5500 |
| NPI Number | 1992101539 |
|---|---|
| Provider Enumeration Date | 11/10/2014 |
| Last Update Date | 11/10/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992101539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN013813 (Georgia) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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