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Organization
SWL DENTAL
Active
Organization
SWL DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SLADE WALLACE LAIL D.D.S. (DENTIST/OWNER)
(770) 476-5227
Entity
Organization
Contact information
Practice address
3415 E LAWRENCEVILLE ST, DULUTH, GA 30096-3354
(770) 476-5227
Mailing address
3415 E LAWRENCEVILLE ST, P.O. BOX 610, DULUTH, GA 30096-3354
(770) 476-5227
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
11701
GA
Other
Enumeration date
07/07/2011
Last updated
07/07/2011
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