Organization
EAGLIN DENTAL GROUP, JOHNS CREEK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON S EAGLIN DDS (OWNER)
(770) 418-1777
Entity
Organization
Contact information
Practice address
6290 ABBOTTS BRIDGE RD STE 101, JOHNS CREEK, GA 30097-1750
(770) 418-1777
(678) 646-5982
Mailing address
6290 ABBOTTS BRIDGE RD STE 101, JOHNS CREEK, GA 30097-1750
(770) 418-1777
(678) 646-5982
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013169
GA
1223P0221X
Pediatric Dentistry
DN013169
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
777472578D
—
GA
Enumeration date
11/18/2011
Last updated
11/18/2011
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