| Dentistry 4 Kids | |
|
3525 Lawrenceville Suwanee Rd Suite 100 Suwanee GA 30024-6568 | |
| (770) 614-4678 | |
| (770) 614-4878 |
| Full Name | Dentistry 4 Kids |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3525 Lawrenceville Suwanee Rd, Suwanee, Georgia |
| Authorized Official Name and Position | Deide Smith (RECEPTIONIST) |
| Authorized Official Contact | 7706144678 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dentistry 4 Kids 3525 Lawrenceville Suwanee Rd Suite 100 Suwanee GA 30024-6568 Ph: (770) 614-4678 | Dentistry 4 Kids 3525 Lawrenceville Suwanee Rd Suite 100 Suwanee GA 30024-6568 Ph: (770) 614-4678 |
| NPI Number | 1790944734 |
|---|---|
| Provider Enumeration Date | 06/05/2008 |
| Last Update Date | 06/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790944734 | NPI | - | NPPES |
| 000661438C | Medicaid | GA | |
| 000900974F | Medicaid | GA | |
| 000273996C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 012241 (Georgia) | Secondary |
| 122300000X | Dentist | DN011335 (Georgia) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | 9560 (Georgia) | Primary |
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