| Southern Smiles Family Dentistry, Inc. | |
|
475 Bill Kennedy Way Se Suite D & E Atlanta GA 30316-6847 | |
| (404) 622-0622 | |
| (404) 622-0624 |
| Full Name | Southern Smiles Family Dentistry, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 475 Bill Kennedy Way Se, Atlanta, Georgia |
| Authorized Official Name and Position | Genise A Evans (DENTIST) |
| Authorized Official Contact | 4046220622 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Smiles Family Dentistry, Inc. 475 Bill Kennedy Way Se Suite D & E Atlanta GA 30316-6847 Ph: (404) 622-0622 | Southern Smiles Family Dentistry, Inc. 475 Bill Kennedy Way Se Suite D & E Atlanta GA 30316-6847 Ph: (404) 622-0622 |
| NPI Number | 1720395924 |
|---|---|
| Provider Enumeration Date | 09/09/2010 |
| Last Update Date | 09/09/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720395924 | NPI | - | NPPES |
| 1548362718 | Other | GA | INDIVIDUAL NPI # |
| 000957712K | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN012623 (Georgia) | Primary |
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