Organization
GEORGIA DENTAL PROFESSIONALS, PC
Active
Parent organization
GEORGIA DENTAL PROFESSIONALS, PC
Other names
Family Dentistry of Northlake
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Authorized official
KIM WILSON (CRED SUP)
(217) 540-5170
Entity
Organization
Contact information
Practice address
3983 LAVISTA RD STE 104, TUCKER, GA 30084-5140
(770) 723-1111
Mailing address
3983 LAVISTA RD STE 104, TUCKER, GA 30084-5140
(770) 723-1111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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