Organization
PRINCETON DENTAL GROUP-LOGANVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN BLAIR (OWNER/OPERATOR)
(404) 324-2012
Entity
Organization
Contact information
Practice address
4353 ATLANTA HWY, LOGANVILLE, GA 30052-3214
(770) 554-0848
(770) 554-4569
Mailing address
1515 WATER SHINE WAY, SNELLVILLE, GA 30078
(404) 324-2012
(678) 344-4642
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN011481
GA
Other
Enumeration date
11/07/2011
Last updated
09/28/2014
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