| Family Dentistry Of Northlake | |
|
3983 Lavista Rd Ste 104 Tucker GA 30084-5140 | |
| (770) 723-1111 | |
| Not Available |
| Full Name | Family Dentistry Of Northlake |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3983 Lavista Rd Ste 104, Tucker, Georgia |
| Authorized Official Name and Position | Kim Wilson (CRED SUP) |
| Authorized Official Contact | 2175405170 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Dentistry Of Northlake 3983 Lavista Rd Ste 104 Tucker GA 30084-5140 Ph: (770) 723-1111 | Family Dentistry Of Northlake 3983 Lavista Rd Ste 104 Tucker GA 30084-5140 Ph: (770) 723-1111 |
| NPI Number | 1215315312 |
|---|---|
| Provider Enumeration Date | 05/11/2015 |
| Last Update Date | 05/11/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215315312 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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Itarut Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3756 La Vista Rd, Suite 102, Tucker, GA 30084 Phone: 404-636-4700 | |
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