Provider Demographics
NPI:1053062182
Name:BEAUTIFUL SMILES OF BYRON LLC
Entity type:Organization
Organization Name:BEAUTIFUL SMILES OF BYRON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:478-956-4278
Mailing Address - Street 1:123 GRALAN DR
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6344
Mailing Address - Country:US
Mailing Address - Phone:478-956-4278
Mailing Address - Fax:
Practice Address - Street 1:123 GRALAN DR
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6344
Practice Address - Country:US
Practice Address - Phone:478-956-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty