Organization
GEORGIA DENTAL PROFESSIONALS, PC
Active
Parent organization
GEORGIA DENTAL PROFESSIONALS, PC
Other names
Elite Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Authorized official
KIM WILSON (CRED SUP)
(217) 540-5170
Entity
Organization
Contact information
Practice address
3052 SHALLOWFORD RD STE 100, MARIETTA, GA 30062-1252
(770) 587-5655
Mailing address
3052 SHALLOWFORD RD STE 100, MARIETTA, GA 30062-1252
(770) 587-5655
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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