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842 Dacula Rd Suite 102 Dacula GA 30019-3185 | |
| (770) 963-0083 | |
| (770) 963-0084 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 842 Dacula Rd, Dacula, Georgia |
| Authorized Official Name and Position | Cesar Humberto Cardenas (OWNER/PRESIDENT) |
| Authorized Official Contact | 7709630083 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
842 Dacula Rd Suite 102 Dacula GA 30019-3185 Ph: (770) 963-0083 | 842 Dacula Rd Suite 102 Dacula GA 30019-3185 Ph: (770) 963-0083 |
| NPI Number | 1699178657 |
|---|---|
| Provider Enumeration Date | 10/06/2014 |
| Last Update Date | 10/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699178657 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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