Provider Demographics
NPI:1255751897
Name:SMILE TODAY PC
Entity type:Organization
Organization Name:SMILE TODAY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:GAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-429-8690
Mailing Address - Street 1:11055 BOLSTER CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1576
Mailing Address - Country:US
Mailing Address - Phone:678-697-4656
Mailing Address - Fax:770-452-5002
Practice Address - Street 1:4897 BUFORD HWY STE 122
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3670
Practice Address - Country:US
Practice Address - Phone:678-697-4656
Practice Address - Fax:770-452-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA527692709AOtherMEDICARE FOR GEORGIA DEPARTMENT OF COMMUNITY HEALTH