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Organization
DENTAL WELLNESS CENTER OF MARIETTA, LLC
Active
Organization
DENTAL WELLNESS CENTER OF MARIETTA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTIE D LAWRENCE (CORPORATE OPERATIONS COORDINATOR)
(912) 920-5577
Entity
Organization
Contact information
Practice address
2100 ROSWELL RD STE A&B, MARIETTA, GA 30062-0810
(678) 909-1225
(912) 226-3489
Mailing address
PO BOX 60339, SAVANNAH, GA 31420-0339
(912) 920-5577
(912) 226-3489
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497918759
NPI
GA
01
—
DN010747
STATE LICENSE
GA
Enumeration date
03/04/2019
Last updated
06/11/2019
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