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1096 West Ave Sw Conyers GA 30012-5244 | |
| (700) 922-1055 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1096 West Ave Sw, Conyers, Georgia |
| Authorized Official Name and Position | Anushka Amin (PRESIDENT) |
| Authorized Official Contact | 6789106269 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1096 West Ave Sw Conyers GA 30012-5244 Ph: (700) 922-1055 | 1096 West Ave Sw Conyers GA 30012-5244 Ph: (700) 922-1055 |
| NPI Number | 1841730686 |
|---|---|
| Provider Enumeration Date | 02/27/2017 |
| Last Update Date | 02/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841730686 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN014608 (Georgia) | Primary |
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