| Fayetteville Pediatric Dentistry | |
|
320 N Jeff Davis Dr Suite C Fayetteville GA 30214-1669 | |
| (770) 651-1000 | |
| Not Available |
| Full Name | Fayetteville Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 320 N Jeff Davis Dr, Fayetteville, Georgia |
| Authorized Official Name and Position | Vishant Nath (DENTIST) |
| Authorized Official Contact | 7706511000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fayetteville Pediatric Dentistry 320 N Jeff Davis Dr Suite C Fayetteville GA 30214-1669 Ph: (770) 651-1000 | Fayetteville Pediatric Dentistry 320 N Jeff Davis Dr Suite C Fayetteville GA 30214-1669 Ph: (770) 651-1000 |
| NPI Number | 1073056933 |
|---|---|
| Provider Enumeration Date | 11/28/2016 |
| Last Update Date | 11/28/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073056933 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN013057 (Georgia) | Primary |
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