| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1325 Auburn Rd, Dacula, Georgia |
| Authorized Official Name and Position | Devang Shah (DENTIST/OWNER MEMBER) |
| Authorized Official Contact | 6784959500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1325 Auburn Rd Dacula GA 30019-1121 Ph: (678) 495-9500 | 1325 Auburn Rd Dacula GA 30019 Ph: (678) 495-9500 |
| NPI Number | 1760745194 |
|---|---|
| Provider Enumeration Date | 06/20/2012 |
| Last Update Date | 05/16/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760745194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN013630 (Georgia) | Primary |
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