Organization Active NPI

Smiles of Decatur P.C.

  • Dentist
  • Decatur, GA
National Provider Identifier
1780036848
Registry record updated Jul 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
013549 Issued in GA
Legal business name
SMILES OF DECATUR P.C.
Practice address
2458 Wesley Chapel Rd Ste B
Decatur, GA 30035-3423
Phone
(770) 322-0059
NPI assigned
Jul 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2016

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

Authorized official

Name
Mauzard Benjamin
Title
Ceo
Phone
(770) 322-0059

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 013549 GA Primary

Addresses

Primary practice location

2458 Wesley Chapel Rd Ste B
Decatur, GA 30035-3423

Mailing address

2458 Wesley Chapel Rd Ste B
Decatur, GA 30035-3423
Phone (770) 322-0059

National Provider Directory

National Provider Directory

Locations

2458 Wesley Chapel Rd
Ste B
Decatur, GA 30035
Phone (770) 322-0059

Practitioners & affiliated clinicians

Practitioners 1

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": "1468281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468281600000",
    "number": "1780036848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2458 WESLEY CHAPEL RD STE B",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300353423",
            "telephone_number": "770-322-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2458 WESLEY CHAPEL RD STE B",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300353423",
            "telephone_number": "770-322-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILES OF DECATUR P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-12",
        "last_updated": "2016-07-12",
        "status": "A",
        "authorized_official_last_name": "BENJAMIN",
        "authorized_official_first_name": "MAUZARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-322-0059"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "013549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; 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.