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Organization
KENNESTONE PERIODONTICS OF MARIETTA, PC
Active
Organization
KENNESTONE PERIODONTICS OF MARIETTA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER C SHATZ DDS (PRESIDENT)
(770) 422-0642
Entity
Organization
Contact information
Practice address
611 CAMPBELL HILL ST NW, SUITE 102, MARIETTA, GA 30060-1386
(770) 422-0642
(770) 422-0643
Mailing address
2070 S PARK PL SE, SUITE 200, ATLANTA, GA 30339-2045
(770) 952-5432
(770) 952-3011
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
10742
GA
1223P0300X
Periodontics
11384
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811082183
PERSONAL NPI NUMBER
GA
01
—
1982798716
PERSONAL NPI NUMBER
GA
Enumeration date
02/08/2011
Last updated
02/08/2011
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