NPIMap

Organization Active NPI

Smile Brite Dental

  • Dentist
  • Stockbridge, GA
National Provider Identifier
1205939899
Registry record updated Mar 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
11980 Issued in GA
Legal business name
SMILE BRITE DENTAL
Practice address
4084 N Henry Blvd
Stockbridge, GA 30281
Phone
(770) 474-7223
Fax
(770) 474-4614
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alfonso Carlos Fernandez, DDSNPI 1336581974
Title
Dentist
Phone
(770) 474-7223

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 11980 GA Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 14437 FL

Addresses

Primary practice location

4084 N Henry Blvd
Stockbridge, GA 30281

Mailing address

4084 N Henry Blvd
Stockbridge, GA 30281
Phone (770) 474-7223

National Provider Directory

National Provider Directory

Locations

4084 N Henry Blvd
Stockbridge, GA 30281
Phone (770) 474-7223

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1205939899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4084 N HENRY BLVD",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "30281",
            "telephone_number": "770-474-7223",
            "fax_number": "770-474-4614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4084 N HENRY BLVD",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "30281",
            "telephone_number": "770-474-7223",
            "fax_number": "770-474-4614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE BRITE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "ALFONSO",
        "authorized_official_middle_name": "CARLOS",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-474-7223",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "11980",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "14437",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.