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635 Dacula Rd Suite 105 Dacula GA 30019-2102 | |
| (678) 271-0718 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 635 Dacula Rd, Dacula, Georgia |
| Authorized Official Name and Position | Kendra Walker (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408312 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
635 Dacula Rd Suite 105 Dacula GA 30019-2102 Ph: () - | 635 Dacula Rd Suite 105 Dacula GA 30019-2102 Ph: (678) 271-0718 |
| NPI Number | 1013388552 |
|---|---|
| Provider Enumeration Date | 10/09/2015 |
| Last Update Date | 10/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013388552 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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