Organization
DAVISON FAMILY DENTISTRY, P.C.
Active
Other names
Irish Road Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WILTZ D.D.S. (PRESIDENT)
(770) 916-5031
Entity
Organization
Contact information
Practice address
1058 N IRISH RD, DAVISON, MI 48423-2209
(810) 653-4100
Mailing address
1090 NORTHCHASE PKWY SE, STE 150, MARIETTA, GA 30067-6405
(770) 916-5031
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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