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Organization
CENTERS FOR PEDIATRIC DENTAL SEDATION LLC
Active
Organization
CENTERS FOR PEDIATRIC DENTAL SEDATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS QURAN POLK M.D. (ANESTHESIOLOGIST)
(404) 403-4567
Entity
Organization
Contact information
Practice address
1631 PHOENIX BLVD STE 8, COLLEGE PARK, GA 30349-5545
(678) 545-1682
(678) 519-0701
Mailing address
PO BOX 370160, DECATUR, GA 30037-0160
(404) 403-4567
(678) 519-0701
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
040758
GA
Other
Enumeration date
03/31/2016
Last updated
03/31/2016
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