Organization
NORTH GEORGIA DENTAL SEDATION CENTER
Active
Parent organization
CHILDRENS DENTISTRY AT GAINESVILLE
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDRENS DENTISTRY AT GAINESVILLE
Authorized official
MARIELLA RAMOS (OFFICE MANAGER)
(678) 714-7011
Entity
Organization
Contact information
Practice address
655 JESSE JEWEL PKWY SE, SUITE E, GAINESVILLE, GA 30501
(770) 539-9110
(678) 714-8388
Mailing address
655 JESSE JEWELL PKWY SE, SUITE, GAINESVILLE, GA 30501-3756
(770) 539-9110
(678) 714-8388
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
DN008032
GA
1223P0221X
Pediatric Dentistry
Primary
DN012082
GA
1223P0221X
Pediatric Dentistry
DN013443
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000046582Y
—
GA
05
—
000851727B
—
GA
05
—
500132139C
—
GA
Enumeration date
08/22/2008
Last updated
08/22/2008
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