# SIMPLE SMILES, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336893163
- **Authorized official:** BEN CUTLER (SECRETARY)
- **Authorized official phone:** (607) 743-9474

## Contact information

- **Practice address:** 712 W WALNUT ST, JOHNSON CITY, TN 37604-6524
- **Practice address phone:** (423) 218-0968
- **Mailing address:** 296 S MAIN ST STE 300, ALPHARETTA, GA 30009-1973

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |

## Other

- **Enumeration date:** 02/10/2022
- **Last updated:** 02/10/2022