Organization
DENTISTRY FOR CHILDREN CDCOA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA BLAIR (SUPERVISOR OF MEDICAID)
(770) 331-4014
Entity
Organization
Contact information
Practice address
4536 CHAMBLEE DUNWOODY RD, SUITE 211, ATLANTA, GA 30338-6200
(770) 331-4104
Mailing address
1350 SPRING ST NW, STE 600, ATLANTA, GA 30309-2864
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
08/11/2011
Last updated
08/11/2011
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