| Centers For Pediatric Dental Sedation Llc | |
|
1631 Phoenix Blvd Ste 8 College Park GA 30349-5545 | |
| (678) 545-1682 | |
| (678) 519-0701 |
| Full Name | Centers For Pediatric Dental Sedation Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1631 Phoenix Blvd Ste 8, College Park, Georgia |
| Authorized Official Name and Position | Marcus Quran Polk (ANESTHESIOLOGIST) |
| Authorized Official Contact | 4044034567 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centers For Pediatric Dental Sedation Llc Po Box 370160 Decatur GA 30037-0160 Ph: (404) 403-4567 | Centers For Pediatric Dental Sedation Llc 1631 Phoenix Blvd Ste 8 College Park GA 30349-5545 Ph: (678) 545-1682 |
| NPI Number | 1396108056 |
|---|---|
| Provider Enumeration Date | 03/31/2016 |
| Last Update Date | 03/31/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396108056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 040758 (Georgia) | Primary |
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