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Organization
MICHELLE GWYN DDS, PC
Active
Organization
MICHELLE GWYN DDS, PC
Active
Other names
Perfect Portrait Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE SANDRA GWYN DDS (OWNER)
(678) 304-8408
Entity
Organization
Contact information
Practice address
5040 BILL GARDNER PKWY STE 300, LOCUST GROVE, GA 30248-3758
(678) 304-8408
(689) 304-8409
Mailing address
5040 BILL GARDNER PKWY STE 300, LOCUST GROVE, GA 30248-3758
(678) 304-8408
(689) 304-8409
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN013195
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
675686848C
—
GA
Enumeration date
11/29/2016
Last updated
11/29/2016
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