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2419 Roswell Rd Marietta GA 30062-4955 | |
| (770) 977-5547 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 2419 Roswell Rd, Marietta, Georgia |
| Authorized Official Name and Position | Jonathan Blair Waldron (DENTIST) |
| Authorized Official Contact | 7709775547 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2419 Roswell Rd Marietta GA 30062-4955 Ph: (770) 977-5547 | 2419 Roswell Rd Marietta GA 30062-4955 Ph: (770) 977-5547 |
| NPI Number | 1972090504 |
|---|---|
| Provider Enumeration Date | 04/19/2018 |
| Last Update Date | 08/21/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972090504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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