Fabulous Smiles Of Lilburn
Point of Service in Lilburn, GA. Organization (NPI-2).
NPI number1205211133
StatusActive
Last updated in NPPESJul 21, 2015
Details
- NPI
- 1205211133
- Entity type
- Organization (NPI-2)
- Legal business name
- Fabulous Smiles Of Lilburn
- Organization subpart
- No
- Enumeration date
- Jul 21, 2015
- Last updated
- Jul 21, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 305S00000X | Point of Service | DN011973 | GA | Yes |
Practice location
331 Arcado Rd NwLilburn, GA 30047-3077
Phone 770-557-0788 · Fax 404-420-2951
Mailing address
331 Arcado Rd NwLilburn, GA 30047-3077
Phone 770-557-0788 · Fax 404-420-2951
Authorized official
Nikki Rolls
Office Manager
7705570788
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