Organization
GEORGIA DENTAL PROFESSIONALS, PC
Active
Parent organization
GEORGIA DENTAL PROFESSIONALS, PC
Other names
Innovative Smiles at the Forum
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Authorized official
TABATHA LEMKE (CREDENTIALING COORDINATOR)
(217) 540-6078
Entity
Organization
Contact information
Practice address
5185 PEACHTREE PKWY STE 201, NORCROSS, GA 30092-6539
(770) 368-1110
Mailing address
5185 PEACHTREE PKWY STE 201, NORCROSS, GA 30092-6539
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/22/2020
Last updated
07/22/2020
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