Organization
CHILDREN AND TEEN DENTAL GROUP
Active
Parent organization
CHILDREN AND TEEN DENTAL GROUP
Other names
American Dental of Fitzgerald
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN AND TEEN DENTAL GROUP
Authorized official
NICOLE D CARIDE (CREDENTIALING MANAGER)
(727) 226-0186
Entity
Organization
Contact information
Practice address
320 BENJAMIN H HILL DR SW, FITZGERALD, GA 31750-8694
(229) 423-9471
Mailing address
2300 LAKEVIEW PKWY STE 250, ALPHARETTA, GA 30009-3954
(470) 207-3264
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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