Provider Demographics
NPI:1063164358
Name:SMILE STUDIO OF BUFORD, LLC
Entity type:Organization
Organization Name:SMILE STUDIO OF BUFORD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-528-0772
Mailing Address - Street 1:2725 HAMILTON MILL RD STE 700
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6010
Mailing Address - Country:US
Mailing Address - Phone:678-528-0772
Mailing Address - Fax:
Practice Address - Street 1:2725 HAMILTON MILL RD
Practice Address - Street 2:STE 700
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-6010
Practice Address - Country:US
Practice Address - Phone:678-528-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic