Organization
SMOKE RISE DENTAL
Active
Other names
Smoke Rise Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER JORDAN ROGERS (CREDENTIALING SPECIALIST)
(470) 801-4637
Entity
Organization
Contact information
Practice address
5500 LILBURN STONE MOUNTAIN RD STE A, STONE MOUNTAIN, GA 30087-2873
(770) 923-5500
(770) 559-9295
Mailing address
5500 LILBURN STONE MOUNTAIN RD STE A, STONE MOUNTAIN, GA 30087-2873
(770) 923-5500
(770) 559-9295
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN013813
GA
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
11/10/2014
Last updated
08/11/2026
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