# METRO DEKALB DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134372279
- **Authorized official:** GARY SIMMS D.M.D. (DENTIST)
- **Authorized official phone:** (404) 296-4119

## Contact information

- **Practice address:** 4849 MEMORIAL DR, STONE MOUNTAIN, GA 30083-4175
- **Practice address phone:** (404) 296-4119
- **Practice address fax:** (404) 935-0905
- **Mailing address:** 4849 MEMORIAL DR, STONE MOUNTAIN, GA 30083-4175
- **Mailing address phone:** (404) 296-4119
- **Mailing address fax:** (404) 935-0905

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DN013291 | GA | Yes |

## Other

- **Enumeration date:** 11/03/2008
- **Last updated:** 11/03/2008