Provider Demographics
NPI:1396167391
Name:SMILE ENVY PC
Entity type:Organization
Organization Name:SMILE ENVY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-422-8116
Mailing Address - Street 1:4300 PACES FERRY RD SE
Mailing Address - Street 2:SUITE 333
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 PACES FERRY RD SE
Practice Address - Street 2:SUITE 333
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5703
Practice Address - Country:US
Practice Address - Phone:281-566-2554
Practice Address - Fax:281-271-8617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty