Organization
PEDIATRIC SMILE STUDIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EILEEN BUCKLE DDS (DENTIST)
(678) 982-5130
Entity
Organization
Contact information
Practice address
2526 SHALLOWFORD RD, SUITE C, MARIETTA, GA 30066-3053
(678) 813-0500
(678) 813-0600
Mailing address
2526 SHALLOWFORD RD, SUITE C, MARIETTA, GA 30066-3053
(678) 813-0500
(678) 813-0600
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN014232
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003108300
—
GA
Enumeration date
05/21/2013
Last updated
05/21/2013
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