# INNOVATIVE SMILES AT THE FORUM PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Second Facility Opened
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861403552
- **Authorized official:** DR. PHILIP K TALLEY DDS (DENTIST OWNER)
- **Authorized official phone:** (770) 368-1110

## Contact information

- **Practice address:** 5185 PEACHTREE PKWY, BLDG 1200 STE 201, NORCROSS, GA 30092
- **Practice address phone:** (770) 368-1110
- **Practice address fax:** (770) 368-1114
- **Mailing address:** 5185 PEACHTREE PKWY, BLDG 1200 STE 201, NORCROSS, GA 30092
- **Mailing address phone:** (770) 368-1110
- **Mailing address fax:** (770) 368-1114

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 08/22/2020