| Mouthpeace Dental 2, Pc | |
|
1833 Delowe Dr Sw Building A Atlanta GA 30311-4701 | |
| (404) 793-2570 | |
| (404) 793-2577 |
| Full Name | Mouthpeace Dental 2, Pc |
|---|---|
| Speciality | Dentist |
| Location | 1833 Delowe Dr Sw, Atlanta, Georgia |
| Authorized Official Name and Position | Syretta Wells (OWNER) |
| Authorized Official Contact | 4047932570 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mouthpeace Dental 2, Pc 1833 Delowe Dr Sw Building A Atlanta GA 30311-4701 Ph: (404) 793-2570 | Mouthpeace Dental 2, Pc 1833 Delowe Dr Sw Building A Atlanta GA 30311-4701 Ph: (404) 793-2570 |
| NPI Number | 1124552203 |
|---|---|
| Provider Enumeration Date | 04/17/2017 |
| Last Update Date | 04/17/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124552203 | NPI | - | NPPES |
| 003180368A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN013505 (Georgia) | Primary |
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