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600 Chastain Rd Nw Ste 426 - Iclear Orthodontics Kennesaw GA 30144-3004 | |
| (404) 902-5327 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 600 Chastain Rd Nw, Kennesaw, Georgia |
| Authorized Official Name and Position | Kalpeshkumar Thakkar (MEMBER) |
| Authorized Official Contact | 4049025327 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
625 W Crossville Rd Ste 200 Roswell GA 30075-7503 Ph: (404) 902-5327 | 600 Chastain Rd Nw Ste 426 - Iclear Orthodontics Kennesaw GA 30144-3004 Ph: (404) 902-5327 |
| NPI Number | 1770948812 |
|---|---|
| Provider Enumeration Date | 12/16/2015 |
| Last Update Date | 12/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770948812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Secondary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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