Organization
GWINNETT SMILE DESIGN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATLYNN PITTMAN (OFFICE MANAGER)
(770) 995-9990
Entity
Organization
Contact information
Practice address
603 OLD NORCROSS RD, SUITE B, LAWRENCEVILLE, GA 30046-4315
(770) 995-9990
Mailing address
603 OLD NORCROSS RD, SUITE B, LAWRENCEVILLE, GA 30046-4315
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN014749
GA
122300000X
Dentist
DN14715
GA
1223G0001X
General Practice Dentistry
Primary
DN014749
GA
124Q00000X
Dental Hygienist
DH003931
GA
124Q00000X
Dental Hygienist
DH005357
GA
Other
Enumeration date
09/20/2016
Last updated
09/20/2016
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