Organization
ATLANTA EMERGENCY DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEON GRAYLAND PYE D.M.D. (PRESIDENT)
(770) 934-0770
Entity
Organization
Contact information
Practice address
4060 LAVISTA RD, TUCKER, GA 30084-5216
(770) 934-0770
(770) 934-3063
Mailing address
4060 LAVISTA RD, TUCKER, GA 30084-5216
(770) 934-0770
(770) 934-3063
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8962
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00172235F
—
GA
Enumeration date
07/22/2009
Last updated
07/22/2009
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