Organization
GEORGIA DENTAL PROFESSIONALS, PC
Active
Parent organization
GEORGIA DENTAL PROFESSIONALS, PC
Other names
Baker Road Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Authorized official
JESSICA BRITT (CREDENTIALING COORDINATOR)
(217) 540-5100
Entity
Organization
Contact information
Practice address
4090 JILES RD NW, KENNESAW, GA 30144-1105
(678) 915-9496
(678) 224-6155
Mailing address
4090 JILES RD NW, KENNESAW, GA 30144-1105
(678) 915-9496
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/29/2020
Last updated
01/15/2021
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