Organization
TREMONT ROAD DENTAL SUPER, P.C.
Active
Other names
Pine Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JACOMINO (DIRECTOR OF PAYOR RELATIONS)
(770) 916-5036
Entity
Organization
Contact information
Practice address
2000 DANIEL STUART SQ, WOODBRIDGE, VA 22191-3315
(770) 916-9000
Mailing address
210 INTERSTATE NORTH PKWY SE STE 300, ATLANTA, GA 30339-2233
(770) 916-9000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401411091
VA
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
08/23/2007
Last updated
01/18/2024
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