Organization
ONE SMILE AWAY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYJUAN MARCQUELL WILLIAMS DMD (OWNER)
(706) 231-0170
Entity
Organization
Contact information
Practice address
4159 ELDERS DR, AUGUSTA, GA 30909-9145
(706) 231-0170
Mailing address
4045 JIMMIE DYESS PKWY, AUGUSTA, GA 30909-9491
(706) 231-0170
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN017325
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003107901A
—
GA
Enumeration date
09/19/2013
Last updated
09/19/2013
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