| Dentistry At Kennesaw Point | |
|
1350 Wooten Lake Rd Nw Suite 203 Kennesaw GA 30144-1344 | |
| (678) 275-2066 | |
| (678) 275-2074 |
| Full Name | Dentistry At Kennesaw Point |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1350 Wooten Lake Rd Nw, Kennesaw, Georgia |
| Authorized Official Name and Position | Kyandukhta Kalantari (OWNER) |
| Authorized Official Contact | 6782752066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dentistry At Kennesaw Point 1350 Wooten Lake Rd Nw Suite 203 Kennesaw GA 30144-1344 Ph: (678) 275-2066 | Dentistry At Kennesaw Point 1350 Wooten Lake Rd Nw Suite 203 Kennesaw GA 30144-1344 Ph: (678) 275-2066 |
| NPI Number | 1003278904 |
|---|---|
| Provider Enumeration Date | 03/22/2016 |
| Last Update Date | 03/22/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003278904 | NPI | - | NPPES |
| 154041182L | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN013605 (Georgia) | Primary |
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