Great Smile Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

011733 Issued in GA

Legal business name

GREAT SMILE DENTAL

Practice address

2145 Roswell Rd
Ste 120
Marietta, GA 30062-0821

Phone

(770) 565-1010

Fax

(770) 565-1037

NPI assigned

Feb 1, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Supriti Balyan, DDSNPI 1073838561

Title

Ceo

Phone

(770) 565-1010

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Supriti Balyan, DDS

  • Dentist
  • Marietta, GA
  • NPI 1073838561
  NPD (past) Authorized official

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269820800000",
    "number": "1457499642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2145 ROSWELL RD",
            "address_2": "STE 120",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300620821",
            "telephone_number": "770-565-1010",
            "fax_number": "770-565-1037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2145 ROSWELL RD",
            "address_2": "STE 120",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300620821",
            "telephone_number": "770-565-1010",
            "fax_number": "770-565-1037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT SMILE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2010-03-29",
        "status": "A",
        "authorized_official_last_name": "BALYAN",
        "authorized_official_first_name": "SUPRITI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-565-1010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "011733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "350681612A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shireon Deque' Gray
• Tamara Gray
• Trayce Gray
• Lukecia T. Grayson
• Great Care Nemt LLC
• Greater Atlanta Behavioral Clinic LLC
• Greater Atlanta Speech & Language Clinics, Inc.
• Joyce Nedree Greaves, LPC
• Paula C Greaves, MD
• Green Parkpch,Inc

• General Practice Dentistry in Marietta, GA
• Providers in Marietta, 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 Mar 29, 2010; 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.