Organization
STEELE FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CECOLIA LAVONT STEELE DDS (OWNER)
(770) 592-7000
Entity
Organization
Contact information
Practice address
116 MIRRAMOUNT LAKE DR, WOODSTOCK, GA 30189-8213
(770) 592-7000
(770) 517-7403
Mailing address
116 MIRRAMOUNT LAKE DR, WOODSTOCK, GA 30189-8213
(770) 592-7000
(770) 517-7403
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN009205
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00210834C
—
GA
Enumeration date
02/18/2010
Last updated
02/18/2010
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