# SACRED DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932461860
- **Authorized official:** DR. AGATHA NWIZU (DENTIST)
- **Authorized official phone:** (770) 474-9202

## Contact information

- **Practice address:** 1360 DOGWOOD DRIVE, CONYERS, GA 30013
- **Practice address phone:** (770) 474-9202
- **Mailing address:** 1360 DOGWOOD DR SE, CONYERS, GA 30013-5075
- **Mailing address phone:** (770) 474-9202
- **Mailing address fax:** (770) 474-9842

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DN013176 | GA | Yes |

## Other

- **Enumeration date:** 06/15/2012
- **Last updated:** 06/15/2012