Fabulous Smilesp.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN011947 Issued in GA

Legal business name

FABULOUS SMILESP.C.

Practice address

1188 Ralph David Abernathy Blvd. Suite 101
Atlanta, GA 30310

Phone

(678) 206-0199

Fax

(404) 529-4465

NPI assigned

Apr 8, 2008

Organization subpart

No

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

Authorized official

Name

Aldous Wilson

Title

Owner

Phone

(678) 206-0199

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Fabulous Smilespc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Fabulous Smiles P.C.

  • General Practice Dentistry
  • Atlanta, GA
  • NPI 1619140928
  NPD tax ID
• Fabulous Smiles P.C.

  • General Practice Dentistry
  • Atlanta, GA
  • NPI 1982930806
  NPD tax ID

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207612800000",
    "number": "1235302563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1188 RALPH DAVID ABERNATHY BLVD. SUITE 101",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30310",
            "telephone_number": "678-206-0199",
            "fax_number": "404-529-4465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1188 RALPH DAVID ABERNATHY BLVD. SUITE 101",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30310",
            "telephone_number": "678-206-0199",
            "fax_number": "404-529-4465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FABULOUS SMILESP.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-08",
        "last_updated": "2008-04-08",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ALDOUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-206-0199"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN011947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00809025B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jorge Fabregas, MD
• Gail Diane Fabrizio, MS APRN BC
• Fabulous Smiles of Atlanta LLC
• Fabulous Smiles P.C.
• Fabulous Smiles P.C.
• Kristen Melissa Marie Facey, MD
• Facility Investments, L.P.
• Carl David Fackler, MD
• Stewart A Factor, D.O.
• Jo D Faddis, DMIN

• General Practice Dentistry in Atlanta, GA
• Providers in Atlanta, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; 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.