| Perfect Portrait Family Dentistry | |
|
5040 Bill Gardner Pkwy Ste 300 Locust Grove GA 30248-3758 | |
| (678) 304-8408 | |
| (689) 304-8409 |
| Full Name | Perfect Portrait Family Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 5040 Bill Gardner Pkwy Ste 300, Locust Grove, Georgia |
| Authorized Official Name and Position | Michelle Sandra Gwyn (OWNER) |
| Authorized Official Contact | 6783048408 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Perfect Portrait Family Dentistry 5040 Bill Gardner Pkwy Ste 300 Locust Grove GA 30248-3758 Ph: (678) 304-8408 | Perfect Portrait Family Dentistry 5040 Bill Gardner Pkwy Ste 300 Locust Grove GA 30248-3758 Ph: (678) 304-8408 |
| NPI Number | 1740723311 |
|---|---|
| Provider Enumeration Date | 11/29/2016 |
| Last Update Date | 11/29/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740723311 | NPI | - | NPPES |
| 675686848C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN013195 (Georgia) | Primary |
Smile Parlor Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2714 Highway 155, Locust Grove, GA 30248 Phone: 470-502-0820 Fax: 470-502-0821 | |
Dentfirst, P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 680 Market Place Blvd.,, Suite A, Locust Grove, GA 30248 Phone: 770-446-8000 |