| Grant Park Dental Group Pc | |
|
465 Boulevard Se Ste 207a Atlanta GA 30312-3483 | |
| (404) 624-1230 | |
| (404) 624-1210 |
| Full Name | Grant Park Dental Group Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 465 Boulevard Se Ste 207a, Atlanta, Georgia |
| Authorized Official Name and Position | Ashish Pravin Vakharia (PRESIDENT) |
| Authorized Official Contact | 4127167907 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grant Park Dental Group Pc 465 Boulevard Se Ste 207a Atlanta GA 30312-3483 Ph: (404) 624-1230 | Grant Park Dental Group Pc 465 Boulevard Se Ste 207a Atlanta GA 30312-3483 Ph: (404) 624-1230 |
| NPI Number | 1679877005 |
|---|---|
| Provider Enumeration Date | 12/28/2010 |
| Last Update Date | 12/28/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679877005 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN013218 (Georgia) | Primary |
| 1223G0001X | Dentist - General Practice | DN012466 (Georgia) | Secondary |
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