Organization
CHILDRENS DENTAL VILLAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRIYA MADHIWALA DMD (DENTIST/OWNER)
(678) 352-8108
Entity
Organization
Contact information
Practice address
9420 WILLEO RD, SUITE 104, ROSWELL, GA 30075-6772
(678) 352-8108
(678) 352-8107
Mailing address
9420 WILLEO RD, SUITE 104, ROSWELL, GA 30075-6772
(678) 352-8108
(678) 352-8107
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN014199
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003106680
—
GA
01
—
1861641698
INDIVIDUAL NPI
GA
Enumeration date
12/12/2014
Last updated
12/22/2014
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