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Organization

CANTON PEDIATRIC DENTISTRY PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. VISHANT NATH DMD (OWNER)
(678) 763-2600
Entity
Organization

Contact information

Practice address
3395 SIXES RD, SUITE 140, CANTON, GA 30114
(678) 763-2600
(678) 893-0459
Mailing address
3395 SIXES RD, SUITE 140, CANTON, GA 30114
(678) 763-2600
(678) 893-0459

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN013057
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
761564386
GA
Enumeration date
02/11/2009
Last updated
02/11/2009
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