| Kennestone Periodontics Of Marietta, Pc | |
|
611 Campbell Hill St Nw Suite 102 Marietta GA 30060-1386 | |
| (770) 422-0642 | |
| (770) 422-0643 |
| Full Name | Kennestone Periodontics Of Marietta, Pc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 611 Campbell Hill St Nw, Marietta, Georgia |
| Authorized Official Name and Position | Peter C Shatz (PRESIDENT) |
| Authorized Official Contact | 7704220642 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kennestone Periodontics Of Marietta, Pc 2070 S Park Pl Se Suite 200 Atlanta GA 30339-2045 Ph: (770) 952-5432 | Kennestone Periodontics Of Marietta, Pc 611 Campbell Hill St Nw Suite 102 Marietta GA 30060-1386 Ph: (770) 422-0642 |
| NPI Number | 1316243389 |
|---|---|
| Provider Enumeration Date | 02/08/2011 |
| Last Update Date | 02/08/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316243389 | NPI | - | NPPES |
| 1982798716 | Other | GA | PERSONAL NPI NUMBER |
| 1811082183 | Other | GA | PERSONAL NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 11384 (Georgia) | Secondary |
| 1223P0300X | Dentist - Periodontics | 10742 (Georgia) | Primary |
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