Organization
VILLA RICA DENTAL SMILES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRAVEEN R GUDIPATI DMD (OWNER)
(404) 966-7766
Entity
Organization
Contact information
Practice address
600 CARROLLTON VILLA RICA HWY STE 614, VILLA RICA, GA 30180-4969
(678) 785-4644
Mailing address
2705 AZALEA BLUFF DR, CUMMING, GA 30041-3207
(404) 966-7766
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/13/2024
Last updated
06/13/2024
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