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Organization
SPARKLING SMILES FAYETTEVILLE LLC
Active
Organization
SPARKLING SMILES FAYETTEVILLE LLC
Active
Other names
Dental Care Alliance
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA JOHNSON (CRO)
(941) 444-0558
Entity
Organization
Contact information
Practice address
1233 HIGHWAY 54 W STE 100, FAYETTEVILLE, GA 30214-4542
(770) 461-6465
Mailing address
1233 HIGHWAY 54 W STE 100, FAYETTEVILLE, GA 30214-4542
(770) 461-6465
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
08/11/2023
Last updated
07/20/2026
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