| Polish Dental Center Marietta Llc | |
|
598 Nancy St Nw Ste 200 Marietta GA 30060-1375 | |
| (770) 642-4711 | |
| Not Available |
| Full Name | Polish Dental Center Marietta Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 598 Nancy St Nw Ste 200, Marietta, Georgia |
| Authorized Official Name and Position | Tiffany Jamison (OWNER/CEO) |
| Authorized Official Contact | 2027148433 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Polish Dental Center Marietta Llc Po Box 2036 Alpharetta GA 30023-2036 Ph: (770) 642-4711 | Polish Dental Center Marietta Llc 598 Nancy St Nw Ste 200 Marietta GA 30060-1375 Ph: (770) 642-4711 |
| NPI Number | 1538826359 |
|---|---|
| Provider Enumeration Date | 11/29/2021 |
| Last Update Date | 11/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538826359 | NPI | - | NPPES |
| 003111882A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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