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Organization

DENTAL WELLNESS CENTER OF MARIETTA, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. CHRISTIE D LAWRENCE (CORPORATE OPERATIONS COORDINATOR)
(912) 920-5577
Entity
Organization

Contact information

Practice address
2100 ROSWELL RD STE A&B, MARIETTA, GA 30062-0810
(678) 909-1225
(912) 226-3489
Mailing address
PO BOX 60339, SAVANNAH, GA 31420-0339
(912) 920-5577
(912) 226-3489

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1497918759
NPI
GA
01
DN010747
STATE LICENSE
GA
Enumeration date
03/04/2019
Last updated
06/11/2019
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