Organization
PARKSIDE PEDIATRIC AND ORTHODONTIC CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARVORIA RUSS (OPERATIONS MANAGER)
(404) 631-7303
Entity
Organization
Contact information
Practice address
155 CARNEGIE PL STE 201A, FAYETTEVILLE, GA 30214-3981
(678) 228-4266
(404) 521-4120
Mailing address
155 CARNEGIE PL STE 201A, FAYETTEVILLE, GA 30214-3981
(678) 228-4266
(404) 521-4120
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
08/08/2023
Last updated
08/08/2023
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