Organization
PEDIATRIC DENTAL SPECIALIST OF HIRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MINDY LYNN SIMMS DDS (PRESIDENT)
(330) 289-6019
Entity
Organization
Contact information
Practice address
5604 WENDY BAGWELL PKWY, SUITE 1100, HIRAM, GA 30141-7813
(770) 943-0011
Mailing address
5604 WENDY BAGWELL PKWY, SUITE 1100, HIRAM, GA 30141-7813
(770) 943-0011
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN013367
GA
Other
Enumeration date
04/27/2015
Last updated
04/27/2015
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