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1955 N Cobb Pkwy Nw Ste 110 Kennesaw GA 30152-4503 | |
| (770) 799-8964 | |
| (678) 888-5809 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1955 N Cobb Pkwy Nw, Kennesaw, 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 | 1955 N Cobb Pkwy Nw Ste 110 Kennesaw GA 30152-4503 Ph: (770) 799-8964 |
| NPI Number | 1942748751 |
|---|---|
| Provider Enumeration Date | 02/01/2017 |
| Last Update Date | 02/01/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942748751 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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