Provider Demographics
NPI:1053801134
Name:BEAUTIFUL SMILES BY DESIGN
Entity type:Organization
Organization Name:BEAUTIFUL SMILES BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUDZAI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKWAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-625-8888
Mailing Address - Street 1:805 RED BUD RD NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1968
Mailing Address - Country:US
Mailing Address - Phone:706-625-8888
Mailing Address - Fax:205-718-8643
Practice Address - Street 1:805 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1968
Practice Address - Country:US
Practice Address - Phone:706-625-8888
Practice Address - Fax:205-718-8643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA148481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1093943391OtherCOMMERICAL INSURANCE