Organization
BENTWATER COSMETIC AND FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY THRELKELD DO (BUSINESS MANAGER)
(678) 499-3514
Entity
Organization
Contact information
Practice address
351 THORNTON RD STE 101, LITHIA SPRINGS, GA 30122-1589
(770) 944-9755
(770) 944-1261
Mailing address
351 THORNTON RD STE 101, LITHIA SPRINGS, GA 30122-1589
(770) 944-9755
(770) 944-1261
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN011428
DENTAL LICENSE NUMBER
GA
Enumeration date
05/26/2022
Last updated
07/27/2022
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