Sparkling Smiles Fayetteville LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SPARKLING SMILES FAYETTEVILLE LLC

Practice address

1233 Highway 54 W Ste 100
Fayetteville, GA 30214-4542

Phone

(770) 461-6465

NPI assigned

Aug 11, 2023

Last updated

Jul 20, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Victoria Johnson

Title

Cro

Phone

(941) 444-0558

Specialties & licenses 1

Addresses

Other names 1

• Dental Care Alliance Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lauren Lee Polito, D.M.D

  • Dentist
  • Fayetteville, GA
  • NPI 1770868382
  NPD

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

{
    "created_epoch": "1691712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784505600000",
    "number": "1508549932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 HIGHWAY 54 W STE 100",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144542",
            "telephone_number": "770-461-6465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 HIGHWAY 54 W STE 100",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144542",
            "telephone_number": "770-461-6465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARKLING SMILES FAYETTEVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-11",
        "last_updated": "2026-07-20",
        "certification_date": "2026-07-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CRO",
        "authorized_official_telephone_number": "941-444-0558"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Care Alliance",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; 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.