Organization
BLOSSOM PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WHITNEY LYONS DMD (OWNER/DENTIST)
(770) 609-5603
Entity
Organization
Contact information
Practice address
345 PEACHTREE INDUSTRIAL BLVD STE 1102-1103, SUWANEE, GA 30024-8819
(770) 609-5603
Mailing address
345 PEACHTREE INDUSTRIAL BLVD STE 1102, SUWANEE, GA 30024-8823
(770) 609-4722
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811302474
INDIVIDUAL NPI
GA
Enumeration date
09/19/2022
Last updated
08/03/2023
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