Organization
DENTISTRY FOR CHILDREN OF PEACHTREE CITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES COULTER (PEDIATRIC DENTIST)
(770) 473-1350
Entity
Organization
Contact information
Practice address
1280 HIGHWAY 74 S STE 210, PEACHTREE CITY, GA 30269-3077
(770) 692-7222
(770) 692-7225
Mailing address
295 COUNTRY CLUB DR, STOCKBRIDGE, GA 30281-7350
(770) 473-1350
(770) 692-0098
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
11/10/2010
Last updated
11/10/2010
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