NPIMap

Organization Active NPI

Lake Lanier Smiles

  • Dental Clinic/Center
  • Buford, GA
National Provider Identifier
1235589995
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
LAKE LANIER SMILES
Practice address
4965 Lanier Islands Pkwy
Suite 105
Buford, GA 30518-1700
Phone
(770) 831-0559
NPI assigned
Jun 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Authorized official

Name
Praveen Reddy GudipatiNPI 1700080793
Title
Dentist Owner
Phone
(770) 205-0466

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

4965 Lanier Islands Pkwy
Suite 105
Buford, GA 30518-1700

Mailing address

4965 Lanier Islands Pkwy
Suite 105
Buford, GA 30518-1700
Phone (770) 831-0559

National Provider Directory

National Provider Directory

Locations

4965 Lanier Islands Pkwy
Ste 105
Buford, GA 30518
Phone (770) 831-0559

Practitioners & affiliated clinicians

Practitioners 3

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": "1465862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747008000000",
    "number": "1235589995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4965 LANIER ISLANDS PKWY",
            "address_2": "SUITE 105",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305181700",
            "telephone_number": "770-831-0559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4965 LANIER ISLANDS PKWY",
            "address_2": "SUITE 105",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305181700",
            "telephone_number": "770-831-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE LANIER SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-14",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A",
        "authorized_official_last_name": "GUDIPATI",
        "authorized_official_first_name": "PRAVEEN",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "770-205-0466"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buford, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; 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.