| Atlanta Dental Team Stone Mountain Pc | |
|
1000 Main St Suite F Stone Mountain GA 30083-2978 | |
| (770) 469-1331 | |
| Not Available |
| Full Name | Atlanta Dental Team Stone Mountain Pc |
|---|---|
| Speciality | Dentist |
| Location | 1000 Main St, Stone Mountain, Georgia |
| Authorized Official Name and Position | Darren A Owens (OWNER) |
| Authorized Official Contact | 7704691331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Atlanta Dental Team Stone Mountain Pc 1000 Main St Suite F Stone Mountain GA 30083-2978 Ph: (770) 469-1331 | Atlanta Dental Team Stone Mountain Pc 1000 Main St Suite F Stone Mountain GA 30083-2978 Ph: (770) 469-1331 |
| NPI Number | 1528331923 |
|---|---|
| Provider Enumeration Date | 02/15/2012 |
| Last Update Date | 08/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528331923 | NPI | - | NPPES |
| 000386625A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN09316 (Georgia) | Secondary |
| 122300000X | Dentist | 12130GA (Georgia) | Primary |
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