Organization
GWINNETT ORAL & MAXILLOFACIAL SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. S LYLE ZUCK DMD, MD (PRESIDENT)
(770) 995-7960
Entity
Organization
Contact information
Practice address
171 GWINNETT DR, SUITE B, LAWRENCEVILLE, GA 30045-5686
(770) 995-7960
Mailing address
171 GWINNETT DR, SUITE B, LAWRENCEVILLE, GA 30045-5686
(770) 995-7960
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN013444
GA
Other
Enumeration date
02/08/2008
Last updated
02/08/2008
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