Organization
SMILE MAGIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA MAGUIRE (OFFICE MANAGER)
(770) 480-3751
Entity
Organization
Contact information
Practice address
2880 OLD ALABAMA RD, SUITE 400, ALPHARETTA, GA 30022-5051
(770) 480-3751
Mailing address
2880 OLD ALABAMA RD, SUITE 400, ALPHARETTA, GA 30022-5051
(770) 480-3751
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012444
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN012444
GEORGIA STATE DENTAL LICENSE
GA
01
—
DN012634
GEORGIA STATE DENTAL LICENSE
GA
Enumeration date
02/19/2013
Last updated
02/19/2013
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