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3101 Roswell Rd Suite 164 Marietta GA 30062-7621 | |
| (678) 310-0330 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3101 Roswell Rd, Marietta, Georgia |
| Authorized Official Name and Position | Kendra Walker (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408312 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3101 Roswell Rd Suite 164 Marietta GA 30062-7621 Ph: (678) 310-0330 | 3101 Roswell Rd Suite 164 Marietta GA 30062-7621 Ph: (678) 310-0330 |
| NPI Number | 1720458177 |
|---|---|
| Provider Enumeration Date | 09/29/2015 |
| Last Update Date | 11/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720458177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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