Provider Demographics
NPI:1588426985
Name:NEW SMILES OF DECATUR
Entity type:Organization
Organization Name:NEW SMILES OF DECATUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-593-3426
Mailing Address - Street 1:3069 CLIFTON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3822
Mailing Address - Country:US
Mailing Address - Phone:770-593-3426
Mailing Address - Fax:770-593-3672
Practice Address - Street 1:3069 CLIFTON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3822
Practice Address - Country:US
Practice Address - Phone:770-593-3426
Practice Address - Fax:770-593-3426
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW SMILES OF DECATUR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty