Individual
MS. DEREKA MCKISSACK MCKISSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
374 N DESHON RD STE D, STONE MOUNTAIN, GA 30087-4827
(770) 469-4192
(770) 469-4195
Mailing address
374 N DESHON RD STE D, STONE MOUNTAIN, GA 30087-4827
(770) 469-4192
(770) 469-4195
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
07/11/2013
Last updated
07/11/2013
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