| Main Street Dental Group Pc | |
|
848 Main St Forest Park GA 30297-1465 | |
| (404) 366-3724 | |
| (404) 366-4271 |
| Full Name | Main Street Dental Group Pc |
|---|---|
| Speciality | Dentist |
| Location | 848 Main St, Forest Park, Georgia |
| Authorized Official Name and Position | Juan J Solano (PRESIDENT) |
| Authorized Official Contact | 4043663724 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Dental Group Pc 848 Main St Forest Park GA 30297-1465 Ph: (404) 366-3724 | Main Street Dental Group Pc 848 Main St Forest Park GA 30297-1465 Ph: (404) 366-3724 |
| NPI Number | 1427220458 |
|---|---|
| Provider Enumeration Date | 03/31/2008 |
| Last Update Date | 03/31/2008 |
| Medicare PECOS PAC ID | 8325481476 |
|---|---|
| Medicare Enrollment ID | O20240206002997 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427220458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | DN012689 (Georgia) | Primary |
| Provider Name | Juan Solano |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1548337967 PECOS PAC ID: 4183092745 Enrollment ID: I20240212002480 |
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