Organization
SOUTHERN SMILES FAMILY DENTISTRY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENISE A EVANS DDS (DENTIST)
(404) 622-0622
Entity
Organization
Contact information
Practice address
475 BILL KENNEDY WAY SE, SUITE D & E, ATLANTA, GA 30316-6847
(404) 622-0622
(404) 622-0624
Mailing address
475 BILL KENNEDY WAY SE, SUITE D & E, ATLANTA, GA 30316-6847
(404) 622-0622
(404) 622-0624
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012623
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000957712K
—
GA
01
—
1548362718
INDIVIDUAL NPI #
GA
Enumeration date
09/09/2010
Last updated
09/09/2010
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