| Itarut Dental Llc | |
|
3756 La Vista Rd Suite 102 Tucker GA 30084-5642 | |
| (404) 636-4700 | |
| Not Available |
| Full Name | Itarut Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3756 La Vista Rd, Tucker, Georgia |
| Authorized Official Name and Position | Piyanut Itarut (ORGANIZER) |
| Authorized Official Contact | 6189776071 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Itarut Dental Llc 3756 La Vista Rd Suite 102 Tucker GA 30084-5642 Ph: (404) 636-4700 | Itarut Dental Llc 3756 La Vista Rd Suite 102 Tucker GA 30084-5642 Ph: (404) 636-4700 |
| NPI Number | 1164986113 |
|---|---|
| Provider Enumeration Date | 01/24/2019 |
| Last Update Date | 01/24/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164986113 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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