Organization
INNOVATIVE SMILES AT THE FORUM PC
Active
Other names
Second Facility Opened
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP K TALLEY DDS (DENTIST OWNER)
(770) 368-1110
Entity
Organization
Contact information
Practice address
5185 PEACHTREE PKWY, BLDG 1200 STE 201, NORCROSS, GA 30092
(770) 368-1110
(770) 368-1114
Mailing address
5185 PEACHTREE PKWY, BLDG 1200 STE 201, NORCROSS, GA 30092
(770) 368-1110
(770) 368-1114
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
08/10/2006
Last updated
08/22/2020
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