| Optima Dental Pc | |
|
4825 Sugarloaf Pkwy Lawrenceville GA 30044-8800 | |
| (770) 962-4322 | |
| (678) 407-2787 |
| Full Name | Optima Dental Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4825 Sugarloaf Pkwy, Lawrenceville, Georgia |
| Authorized Official Name and Position | Isioma Anizor (OFFICER) |
| Authorized Official Contact | 7709624322 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Optima Dental Pc 4825 Sugarloaf Pkwy Ste A Lawrenceville GA 30044-8800 Ph: (770) 962-4322 | Optima Dental Pc 4825 Sugarloaf Pkwy Lawrenceville GA 30044-8800 Ph: (770) 962-4322 |
| NPI Number | 1720303480 |
|---|---|
| Provider Enumeration Date | 04/06/2010 |
| Last Update Date | 04/06/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720303480 | NPI | - | NPPES |
| 122300000X | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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