Organization
FAYETTEVILLE PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VISHANT NATH DMD (DENTIST)
(770) 651-1000
Entity
Organization
Contact information
Practice address
320 N JEFF DAVIS DR, SUITE C, FAYETTEVILLE, GA 30214-1669
(770) 651-1000
Mailing address
320 N JEFF DAVIS DR, SUITE C, FAYETTEVILLE, GA 30214-1669
(770) 651-1000
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN013057
GA
Other
Enumeration date
11/28/2016
Last updated
11/28/2016
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