Organization
CENTERS FOR PEDIATRIC DENTAL SEDATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS QURAN POLK M.D. (ANESTHESIOLOGIST)
(404) 403-4567
Entity
Organization
Contact information
Practice address
1631 PHOENIX BLVD STE 8, COLLEGE PARK, GA 30349-5545
(678) 545-1682
(678) 519-0701
Mailing address
PO BOX 370160, DECATUR, GA 30037-0160
(404) 403-4567
(678) 519-0701
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
040758
GA
Other
Enumeration date
03/31/2016
Last updated
03/31/2016
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