Organization
WONDERLAND PEDIATRIC DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KARINA BOGDASAROVA DDS (OWNER)
(720) 404-8805
Entity
Organization
Contact information
Practice address
1570 OLD ALABAMA RD STE 104, ROSWELL, GA 30076-2108
(678) 878-3711
(678) 878-3714
Mailing address
1570 OLD ALABAMA RD STE 104, ROSWELL, GA 30076-2108
(678) 878-3711
(678) 878-3714
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN 014759
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003146415
—
GA
Enumeration date
09/23/2014
Last updated
09/23/2014
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