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1920 Ga-20 Suite B Conyers GA 30013-2048 | |
| (770) 767-0603 | |
| (770) 929-4387 |
| Full Name | |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 1920 Ga-20, Conyers, Georgia |
| Authorized Official Name and Position | Brittany Bennett (OFFICE MANAGER) |
| Authorized Official Contact | 7709228733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1920 Ga-20 Suite B Conyers GA 30013-2048 Ph: (770) 767-0603 | 1920 Ga-20 Suite B Conyers GA 30013-2048 Ph: (770) 767-0603 |
| NPI Number | 1639930118 |
|---|---|
| Provider Enumeration Date | 01/22/2024 |
| Last Update Date | 10/31/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639930118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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