| |
683 Piedmont Rd Ne Marietta GA 30066-4811 | |
(770) 794-0808 | |
Not Available |
Full Name | |
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Speciality | Dentist |
Location | 683 Piedmont Rd Ne, Marietta, Georgia |
Authorized Official Name and Position | Hetesh Madev Ranchod (PRESIDENT) |
Authorized Official Contact | 7707940808 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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683 Piedmont Rd Ne Marietta GA 30066-4811 Ph: (770) 794-0808 | 683 Piedmont Rd Ne Marietta GA 30066-4811 Ph: (770) 794-0808 |
NPI Number | 1396864237 |
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Provider Enumeration Date | 03/29/2007 |
Last Update Date | 01/16/2020 |
Medicare PECOS PAC ID | 4587683461 |
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Medicare Enrollment ID | O20160503002705 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396864237 | NPI | - | NPPES |
100696 | Medicaid | GA | |
000683229B | Medicaid | GA | |
107742 | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | DN011401 (Georgia) | Primary |
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