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>> Dentist >> Dental Providers

Registrant NPI Number: 1770639726

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
2285 HWY 411 NORTH  FAIRMOUNT, GA 30139 US
Tel: 706-337-2577  Fax: 678-493-2671

Contact information for business:
Tel: 706-337-2577  Fax: 678-493-2671

Registration Information:
NPI: 1770639726
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers

Legacy codes, insurance codes and state license numbers:



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