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Organization
EASTLIGHT DENTAL, L.L.C.
Active
Organization
EASTLIGHT DENTAL, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDMUND THOMAS JR. DDS (OWNER)
(716) 949-2183
Entity
Organization
Contact information
Practice address
2536 ROCKBRIDGE RD STE 103, STONE MOUNTAIN, GA 30087-3636
(678) 395-5913
Mailing address
2536 ROCKBRIDGE RD STE 103, STONE MOUNTAIN, GA 30087-3636
(678) 395-5913
(678) 395-5678
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/06/2018
Last updated
09/18/2018
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