Individual
KALLIE LAW BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
205 WALESKA RD, SUITE 2A, CANTON, GA 30114-2493
(770) 479-3713
Mailing address
205 WALESKA RD, SUITE 2A, CANTON, GA 30114-2493
(770) 479-3713
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN014538
GA
1223G0001X
General Practice Dentistry
Primary
8162
SC
Other
Enumeration date
12/14/2012
Last updated
02/15/2015
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