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Organization
SMOKE RISE DENTAL
Active
Organization
SMOKE RISE DENTAL
Active
Other names
Smoke Rise Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER JORDAN ROGERS (CREDENTIALING SPECIALIST)
(470) 801-4637
Entity
Organization
Contact information
Practice address
5500 LILBURN STONE MOUNTAIN RD STE A, STONE MOUNTAIN, GA 30087-2873
(770) 923-5500
(770) 559-9295
Mailing address
5500 LILBURN STONE MOUNTAIN RD STE A, STONE MOUNTAIN, GA 30087-2873
(770) 923-5500
(770) 559-9295
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN013813
GA
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
11/10/2014
Last updated
08/11/2026
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