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12385 Crabapple Rd Suite 101 Alpharetta GA 30004-6357 | |
| (770) 781-8650 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 12385 Crabapple Rd, Alpharetta, Georgia |
| Authorized Official Name and Position | Kevin Short (OWNER) |
| Authorized Official Contact | 7707818650 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12385 Crabapple Rd Suite 101 Alpharetta GA 30004-6357 Ph: () - | 12385 Crabapple Rd Suite 101 Alpharetta GA 30004-6357 Ph: (770) 781-8650 |
| NPI Number | 1386193662 |
|---|---|
| Provider Enumeration Date | 09/27/2016 |
| Last Update Date | 09/29/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386193662 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN011242 (Georgia) | Secondary |
| 122300000X | Dentist | DN015174 (Georgia) | Primary |
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