| Lakeshore Mall Dental Group | |
|
150 Pearl Nix Pkwy Suite B10 Gainesville GA 30501-3548 | |
| (770) 536-1957 | |
| (770) 536-3582 |
| Full Name | Lakeshore Mall Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 150 Pearl Nix Pkwy, Gainesville, Georgia |
| Authorized Official Name and Position | Theresa Chatham (DIST MANAGER) |
| Authorized Official Contact | 7705361957 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Mall Dental Group 150 Pearl Nix Pkwy Suite B10 Gainesville GA 30501-3548 Ph: (770) 536-1957 | Lakeshore Mall Dental Group 150 Pearl Nix Pkwy Suite B10 Gainesville GA 30501-3548 Ph: (770) 536-1957 |
| NPI Number | 1346389814 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346389814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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