Individual
GLENN MARON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS FACS
Contact information
Practice address
999 PEACHTREE ST NE, STE 715, ATLANTA, GA 30309
(404) 892-2999
(404) 815-7730
Mailing address
5505 PEACHTREE DUNWOODY RD STE 660, ATLANTA, GA 30342-2018
(404) 892-2999
(404) 815-7730
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
010345
GA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
10345
GA
Other
Enumeration date
04/25/2006
Last updated
07/19/2019
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