Organization
LILBURN DENTAL GROUP, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD GANGWISCH D.D.S. (MEMBER)
(770) 923-3966
Entity
Organization
Contact information
Practice address
912 KILLIAN HILL RD SW, SUITE 100, LILBURN, GA 30047-3138
(770) 923-3966
Mailing address
912 KILLIAN HILL RD SW, SUITE 100, LILBURN, GA 30047-3138
(770) 923-3966
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/20/2006
Last updated
08/22/2020
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