| Oro-facial Center Inc | |
|
3574 Habersham At Northlake Tucker GA 30084-4009 | |
| (770) 934-2339 | |
| Not Available |
| Full Name | Oro-facial Center Inc |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 3574 Habersham At Northlake, Tucker, Georgia |
| Authorized Official Name and Position | James A Davis (OWNER) |
| Authorized Official Contact | 7709342339 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oro-facial Center Inc 3574 Habersham At Northlake Tucker GA 30084-4009 Ph: (770) 934-2339 | Oro-facial Center Inc 3574 Habersham At Northlake Tucker GA 30084-4009 Ph: (770) 934-2339 |
| NPI Number | 1457897928 |
|---|---|
| Provider Enumeration Date | 01/09/2017 |
| Last Update Date | 01/09/2017 |
| Medicare PECOS PAC ID | 3173892635 |
|---|---|
| Medicare Enrollment ID | O20170627002320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457897928 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | (* (Not Available)) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | James Davis |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1942414735 PECOS PAC ID: 1456523687 Enrollment ID: I20111013000069 |
| Provider Name | Prajna Banan |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1952902272 PECOS PAC ID: 3375936826 Enrollment ID: I20220207001056 |
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