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Organization

MOUTHPEACE DENTAL 2, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SYRETTA WELLS DDS (OWNER)
(404) 793-2570
Entity
Organization

Contact information

Practice address
1833 DELOWE DR SW, BUILDING A, ATLANTA, GA 30311-4701
(404) 793-2570
(404) 793-2577
Mailing address
1833 DELOWE DR SW, BUILDING A, ATLANTA, GA 30311-4701
(404) 793-2570
(404) 793-2577

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN013505
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003180368A
GA
Enumeration date
04/17/2017
Last updated
04/17/2017
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