| Childrens Dentistry Of Lithonia Llc | |
|
374 C North Deshon Road Stone Mountain GA 30087 | |
| (770) 469-4192 | |
| (770) 469-4195 |
| Full Name | Childrens Dentistry Of Lithonia Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 374 C North Deshon Road, Stone Mountain, Georgia |
| Authorized Official Name and Position | Adesegun Olushola Tewogbade (OWNER) |
| Authorized Official Contact | 7704694192 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Childrens Dentistry Of Lithonia Llc Po Box 870272 Stone Mountain GA 30087-0007 Ph: (770) 469-4192 | Childrens Dentistry Of Lithonia Llc 374 C North Deshon Road Stone Mountain GA 30087 Ph: (770) 469-4192 |
| NPI Number | 1730348210 |
|---|---|
| Provider Enumeration Date | 06/09/2008 |
| Last Update Date | 06/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730348210 | NPI | - | NPPES |
| 1952449944 | Other | INDIVIDUAL NPI | |
| 853805701A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN013400 (Georgia) | Primary |
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