Organization
DANIEL REDIE GENERAL DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL REDIE (DENTIST)
(770) 996-5850
Entity
Organization
Contact information
Practice address
1849 HIGHWAY 138 SW, RIVERDALE, GA 30296-1812
(770) 996-5850
Mailing address
1849 HIGHWAY 138 SW, RIVERDALE, GA 30296-1812
(770) 996-5850
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100997
AVESIS
GA
01
—
9180091
DORAL
GA
Enumeration date
04/07/2008
Last updated
04/07/2008
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