Organization
CHILDREN AND TEEN DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE CARIDE (CREDENTIALING MANAGER)
(727) 784-2721
Entity
Organization
Contact information
Practice address
5500 LILBURN STONE MOUNTAIN RD STE A, STONE MOUNTAIN, GA 30087-2873
(770) 923-5500
Mailing address
2300 LAKEVIEW PKWY STE 250, ALPHARETTA, GA 30009-3954
(470) 207-3264
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/17/2025
Last updated
11/17/2025
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