Organization
CHILDREN AND TEEN DENTAL GROUP OF PENNSYLVANIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN SMITH (CFO)
(770) 231-5348
Entity
Organization
Contact information
Practice address
105 DOWLIN FORGE RD, EXTON, PA 19341-1550
(610) 363-2100
Mailing address
342 N MAIN ST, STE 200, ALPHARETTA, GA 30009-8376
(770) 744-4522
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
09/20/2016
Last updated
09/20/2016
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