Organization
CHILDREN'S DENTAL CTR AT BROOKSTONE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN WARD SHEALY (CFO)
(770) 422-9375
Entity
Organization
Contact information
Practice address
1825 MARS HILL RD NW, ACWORTH, GA 30101
(770) 422-9375
(770) 528-5976
Mailing address
1825 MARS HILL RD NW, ACWORTH, GA 30101
(770) 422-9375
(770) 528-5976
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
07/20/2007
Last updated
07/20/2007
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