| Southwest Maxillofacial Surgery & Implant Center | |
|
3885 Princeton Lakes Way Sw 406 Atlanta GA 30331-5589 | |
| (404) 629-6610 | |
| (404) 629-6630 |
| Full Name | Southwest Maxillofacial Surgery & Implant Center |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 3885 Princeton Lakes Way Sw, Atlanta, Georgia |
| Authorized Official Name and Position | Jacques Leonel Gordon (PRESIDENT) |
| Authorized Official Contact | 4046296610 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Maxillofacial Surgery & Implant Center 3885 Princeton Lakes Way Sw 406 Atlanta GA 30331-5589 Ph: (404) 629-6610 | Southwest Maxillofacial Surgery & Implant Center 3885 Princeton Lakes Way Sw 406 Atlanta GA 30331-5589 Ph: (404) 629-6610 |
| NPI Number | 1073743795 |
|---|---|
| Provider Enumeration Date | 07/15/2009 |
| Last Update Date | 07/15/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073743795 | NPI | - | NPPES |
| 457061566A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DN013463 (Georgia) | Primary |
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