Individual
DR. LINCOLN ROBERT FANTASKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3698 LARGENT WAY NW STE 202, MARIETTA, GA 30064-5923
(770) 423-4900
Mailing address
3698 LARGENT WAY NW STE 202, MARIETTA, GA 30064-5923
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015906
GA
Other
Enumeration date
06/27/2019
Last updated
07/01/2019
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