# TREMONT ROAD DENTAL SUPER, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Spencer Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346335924
- **Authorized official:** MICHELLE JACOMINO (DIRECTOR OF PAYOR RELATIONS)
- **Authorized official phone:** (770) 916-5036

## Contact information

- **Practice address:** 4722 N. SOUTHSIDE PLAZA STE \#24, RICHMOND, VA 23224
- **Practice address phone:** (804) 319-5665
- **Practice address fax:** (804) 319-5666
- **Mailing address:** 210 INTERSTATE NORTH PKWY SE STE 300, ATLANTA, GA 30339-2233
- **Mailing address phone:** (770) 916-5028
- **Mailing address fax:** (678) 247-7858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 01/18/2024