| Canton Dental, Llc | |
|
230 Riverstone Pkwy Ste A Canton GA 30114-6414 | |
| (770) 479-5425 | |
| Not Available |
| Full Name | Canton Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 230 Riverstone Pkwy Ste A, Canton, Georgia |
| Authorized Official Name and Position | Logan V Gordon (BUSINESS MANAGER) |
| Authorized Official Contact | 7704795425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canton Dental, Llc 230 Riverstone Pkwy Ste A Canton GA 30114-6414 Ph: (770) 479-5425 | Canton Dental, Llc 230 Riverstone Pkwy Ste A Canton GA 30114-6414 Ph: (770) 479-5425 |
| NPI Number | 1841524295 |
|---|---|
| Provider Enumeration Date | 10/01/2009 |
| Last Update Date | 10/01/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841524295 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | GA012160 (Georgia) | Primary |
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