Organization
PERRY STREET DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS F. MOYNAHAN D.M.D. (PRESIDENT)
(770) 251-3465
Entity
Organization
Contact information
Practice address
53 PERRY ST, NEWNAN, GA 30263-1935
(770) 251-3465
Mailing address
1090 NORTHCHASE PKWY SE STE 150, MARIETTA, GA 30067-6407
(770) 916-5031
(678) 247-7966
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
07/06/2016
Last updated
07/06/2016
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