Organization
FABULOUS SMILESP.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALDOUS WILSON (OWNER)
(678) 206-0199
Entity
Organization
Contact information
Practice address
1188 RALPH DAVID ABERNATHY BLVD. SUITE 101, ATLANTA, GA 30310
(678) 206-0199
(404) 529-4465
Mailing address
1188 RALPH DAVID ABERNATHY BLVD. SUITE 101, ATLANTA, GA 30310
(678) 206-0199
(404) 529-4465
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN011947
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00809025B
—
GA
Enumeration date
04/08/2008
Last updated
04/08/2008
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