Organization
SOUTHERN SMILES ORTHODONTICS, LLC
Active
Other names
Southern Smiles Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA WIETH (PAYOR RELATIONS MANAGER)
(440) 563-8819
Entity
Organization
Contact information
Practice address
7475 DOUGLAS BLVD STE 201, DOUGLASVILLE, GA 30135-1519
(770) 942-4100
Mailing address
7475 DOUGLAS BLVD STE 201, DOUGLASVILLE, GA 30135-1519
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
01/17/2025
Last updated
01/17/2025
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