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Organization
TREMONT ROAD DENTAL, PC
Active
Organization
TREMONT ROAD DENTAL, PC
Active
Other names
Spencer Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JACOMINO (DIRECTOR OF PAYOR RELATIONS)
(770) 916-5036
Entity
Organization
Contact information
Practice address
365 LOWES DR, DANVILLE, VA 24540-5900
(770) 916-9000
Mailing address
210 INTERSTATE NORTH PKWY SE STE 300, ATLANTA, GA 30339-2233
(770) 916-9000
(678) 247-7858
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
NULL
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
06/10/2011
Last updated
05/27/2022
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