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1650 County Services Pkwy Sw Marietta GA 30008-4010 | |
| (770) 514-2361 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 1650 County Services Pkwy Sw, Marietta, Georgia |
| Authorized Official Name and Position | Tyler Carlson (ADMINISTRATION DIRECTOR) |
| Authorized Official Contact | 7705142342 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1650 County Services Pkwy Sw Marietta GA 30008-4010 Ph: (770) 514-2361 | 1650 County Services Pkwy Sw Marietta GA 30008-4010 Ph: (770) 514-2361 |
| NPI Number | 1598819690 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598819690 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | DN011004 (Georgia) | Primary |
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