Organization
CARROLLTON FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA SIMS (OFFICE MANAGER)
(770) 439-2550
Entity
Organization
Contact information
Practice address
101 CLINIC AVE, CARROLLTON, GA 30117-4413
(770) 832-1376
Mailing address
126 ENTERPRISE PATH, SUITE #106, HIRAM, GA 30141
(770) 832-1376
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012710
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044992718D
—
GA
Enumeration date
01/17/2007
Last updated
10/06/2011
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