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2100 Roswell Rd Ste 1108 Marietta GA 30062-0883 | |
| (678) 401-5089 | |
| (864) 670-5285 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2100 Roswell Rd Ste 1108, Marietta, Georgia |
| Authorized Official Name and Position | Monique Tucker (DIRECTOR OF INSURANCE) |
| Authorized Official Contact | 8439909998 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4921 Centre Pointe Dr Ste 201 North Charleston SC 29418-6997 Ph: (843) 990-9998 | 2100 Roswell Rd Ste 1108 Marietta GA 30062-0883 Ph: (678) 401-5089 |
| NPI Number | 1376053710 |
|---|---|
| Provider Enumeration Date | 10/11/2017 |
| Last Update Date | 12/08/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376053710 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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