Organization
CEDAR DENTAL CLINICAL I, LLC
Active
Organization
CEDAR DENTAL CLINICAL I, LLC
Active
Other names
Orthodontic Care of Georgia
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY RANKIN DALLAM III DMD (PRESIDENT)
(770) 331-2529
Entity
Organization
Contact information
Practice address
119 WILLOW LN, MCDONOUGH, GA 30253-6574
(678) 432-8505
(678) 432-9419
Mailing address
6801 GOVERNORS LAKE PKWY STE 290, PEACHTREE CORNERS, GA 30071-1136
(678) 978-3099
(678) 691-4425
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN013071
GA DENTAL LICENSE
GA
Enumeration date
09/24/2020
Last updated
09/24/2020
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