Provider Demographics
NPI:1164234506
Name:SMILE ORTHODONTICS, LLC
Entity type:Organization
Organization Name:SMILE ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARUNESH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKOTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-474-7958
Mailing Address - Street 1:2297 NESBITT DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3931
Mailing Address - Country:US
Mailing Address - Phone:516-474-7958
Mailing Address - Fax:
Practice Address - Street 1:755 COMMERCE DR STE 520
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2618
Practice Address - Country:US
Practice Address - Phone:516-474-7958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty