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Organization
NOVA DENTAL, PC
Active
Organization
NOVA DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIANE S REYNOLDS DDS (GENERAL DENTIST)
(770) 253-5885
Entity
Organization
Contact information
Practice address
1134 SENOIA RD STE A2, TYRONE, GA 30290-1622
(770) 253-5885
Mailing address
31 JESSICA LN, NEWNAN, GA 30263-7069
(770) 253-5885
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN013488
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S01262012767946
—
GA
Enumeration date
03/26/2013
Last updated
03/26/2013
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