Individual
DORIAN GRACE LONGSHORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4799 ATLANTA HWY # 500, LOGANVILLE, GA 30052-7307
(404) 609-4661
Mailing address
1746 HOLMES DR SW, CONYERS, GA 30094-4726
(470) 255-4855
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015430
GA
Other
Enumeration date
06/09/2017
Last updated
06/09/2017
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