Provider Demographics
NPI:1053595298
Name:A SMILE 4 U
Entity type:Organization
Organization Name:A SMILE 4 U
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AKIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-387-2783
Mailing Address - Street 1:366 N. MAIN ST.
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009
Mailing Address - Country:US
Mailing Address - Phone:678-387-2873
Mailing Address - Fax:678-387-2784
Practice Address - Street 1:366 N. MAIN ST.
Practice Address - Street 2:SUITE 450
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009
Practice Address - Country:US
Practice Address - Phone:678-387-2783
Practice Address - Fax:678-387-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0115291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1457420937OtherNPPES
GA1922290360OtherNPPES