| Lost Mountain Dental @ Due West | |
|
3951 Mary Eliza Trace Nw Suite 200 Marietta GA 30064 | |
| (770) 425-4001 | |
| (770) 425-7636 |
| Full Name | Lost Mountain Dental @ Due West |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3951 Mary Eliza Trace Nw, Marietta, Georgia |
| Authorized Official Name and Position | Michael Mulkey (OWNER, DENTIST) |
| Authorized Official Contact | 7704254001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lost Mountain Dental @ Due West 3951 Mary Eliza Trce Nw Ste 200 Marietta GA 30064-1078 Ph: (770) 425-4001 | Lost Mountain Dental @ Due West 3951 Mary Eliza Trace Nw Suite 200 Marietta GA 30064 Ph: (770) 425-4001 |
| NPI Number | 1245760859 |
|---|---|
| Provider Enumeration Date | 06/15/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245760859 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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