| Professional Dental Alliance Of Lilburn, Llc | |
|
3970 Five Forks Trickum Rd Sw Ste B Lilburn GA 30047-2339 | |
| (770) 921-8442 | |
| Not Available |
| Full Name | Professional Dental Alliance Of Lilburn, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3970 Five Forks Trickum Rd Sw Ste B, Lilburn, Georgia |
| Authorized Official Name and Position | Jessica Barrette (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7246982997 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Dental Alliance Of Lilburn, Llc 11 S Mill St Ste 200 New Castle PA 16101-3680 Ph: () - | Professional Dental Alliance Of Lilburn, Llc 3970 Five Forks Trickum Rd Sw Ste B Lilburn GA 30047-2339 Ph: (770) 921-8442 |
| NPI Number | 1710544960 |
|---|---|
| Provider Enumeration Date | 05/23/2019 |
| Last Update Date | 05/23/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710544960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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