Organization
GREAT SMILE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUPRITI BALYAN DDS (CEO)
(770) 565-1010
Entity
Organization
Contact information
Practice address
2145 ROSWELL RD, STE 120, MARIETTA, GA 30062-0821
(770) 565-1010
(770) 565-1037
Mailing address
2145 ROSWELL RD, STE 120, MARIETTA, GA 30062-0821
(770) 565-1010
(770) 565-1037
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
011733
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350681612A
—
GA
Enumeration date
02/01/2007
Last updated
03/29/2010
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