Individual
DR. THERESA BETH CONWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.,M.S.
Contact information
Practice address
2302 ENGLISH IVY COURT, SMYRNA, GA 30080
(404) 964-5511
Mailing address
2302 ENGLISH IVY COURT, SMYRNA, GA 30080
(404) 964-5511
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
012367
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012367
DENTAL LICENSE NUMBER
GA
Enumeration date
04/13/2007
Last updated
07/08/2007
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