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3515 Dallas Hwy Ste. B Marietta GA 30064 | |
| (770) 499-7005 | |
| (770) 499-7081 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 3515 Dallas Hwy Ste. B, Marietta, Georgia |
| Authorized Official Name and Position | Sherryl Ann Odonnell (MGR) |
| Authorized Official Contact | 7704997005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3515 Dallas Hwy Ste. B Marietta GA 30064 Ph: (770) 499-7005 | 3515 Dallas Hwy Ste. B Marietta GA 30064 Ph: (770) 499-7005 |
| NPI Number | 1770970915 |
|---|---|
| Provider Enumeration Date | 04/24/2015 |
| Last Update Date | 04/24/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770970915 | NPI | - | NPPES |
| 65978 | Other | GA | DELTA DENTAL OF GA. |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 71012 (Georgia) | Primary |
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