Provider Demographics
NPI:1891585998
Name:SNELLVILLE DENTAL SMILES
Entity type:Organization
Organization Name:SNELLVILLE DENTAL SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-966-7766
Mailing Address - Street 1:2705 AZALEA BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-3207
Mailing Address - Country:US
Mailing Address - Phone:404-966-7766
Mailing Address - Fax:
Practice Address - Street 1:2992 MAIN ST W STE A100
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5764
Practice Address - Country:US
Practice Address - Phone:770-972-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty