| Fabulous Dentistry And Orthodontic Pc | |
|
950 Indian Trl Rd Nw Suite 3-g Lilburn GA 30047-1721 | |
| (678) 325-3970 | |
| (678) 325-3971 |
| Full Name | Fabulous Dentistry And Orthodontic Pc |
|---|---|
| Speciality | Dentist |
| Location | 950 Indian Trl Rd Nw, Lilburn, Georgia |
| Authorized Official Name and Position | Juan J Solano (PRESIDENT) |
| Authorized Official Contact | 6783253970 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fabulous Dentistry And Orthodontic Pc 950 Indian Trl Rd Nw Suite 3-g Lilburn GA 30047-1721 Ph: (678) 325-3970 | Fabulous Dentistry And Orthodontic Pc 950 Indian Trl Rd Nw Suite 3-g Lilburn GA 30047-1721 Ph: (678) 325-3970 |
| NPI Number | 1508038076 |
|---|---|
| Provider Enumeration Date | 03/25/2008 |
| Last Update Date | 02/12/2024 |
| Medicare PECOS PAC ID | 6103269477 |
|---|---|
| Medicare Enrollment ID | O20240205000811 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508038076 | NPI | - | NPPES |
| 502321377B | Medicaid | GA |
| Provider Name | Juan Solano |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1548337967 PECOS PAC ID: 4183092745 Enrollment ID: I20240212002480 |
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