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Organization
POLISH DENTAL CENTER MARIETTA LLC
Active
Organization
POLISH DENTAL CENTER MARIETTA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY JAMISON DDS (OWNER/CEO)
(202) 714-8433
Entity
Organization
Contact information
Practice address
598 NANCY ST NW STE 200, MARIETTA, GA 30060-1375
(770) 642-4711
Mailing address
PO BOX 2036, ALPHARETTA, GA 30023-2036
(770) 642-4711
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003111882A
—
GA
Enumeration date
11/29/2021
Last updated
11/29/2021
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