Organization
FABULOUS SMILES P.C.
Active
Parent organization
FABULOUS SMILES
Other names
FABULOUS SMILES PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FABULOUS SMILES
Authorized official
ALDOUS WILSON (PRESIDENT)
(404) 767-9356
Entity
Organization
Contact information
Practice address
1188 RALPH DAVID ABERNATHY BLVD SW STE 101, ATLANTA, GA 30310-1754
(404) 767-9356
(404) 529-4465
Mailing address
1188 RALPH DAVID ABERNATHY BLVD SW STE 101, ATLANTA, GA 30310-1754
(404) 767-9356
(404) 529-4465
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN011947
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000809025E
—
GA
Enumeration date
10/28/2009
Last updated
10/28/2009
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