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1450 Highway 138 Se Conyers GA 30013-1285 | |
| (770) 285-2270 | |
| (770) 761-6301 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1450 Highway 138 Se, Conyers, Georgia |
| Authorized Official Name and Position | Jennifer La Duc (PROVIDER RELATIONS) |
| Authorized Official Contact | 3154546000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 3189 Syracuse NY 13220-3189 Ph: (315) 454-6000 | 1450 Highway 138 Se Conyers GA 30013-1285 Ph: (770) 285-2270 |
| NPI Number | 1841656246 |
|---|---|
| Provider Enumeration Date | 01/14/2016 |
| Last Update Date | 01/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841656246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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