Organization
EAST 53RD STREET DENTAL-2, P.C.
Active
Other names
Kool Smiles, Kool Smiles INI-2,PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID VIETH (CHIEF DENTAL OFFICER)
(770) 916-9000
Entity
Organization
Contact information
Practice address
2248 E 53RD ST, INDIANAPOLIS, IN 46220-3479
(317) 472-9888
(317) 257-7028
Mailing address
1090 NORTHCHASE PKWY SE STE 150, MARIETTA, GA 30067-6407
(770) 916-5036
(678) 285-4760
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
10/25/2006
Last updated
05/13/2019
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