Organization
DENTAL TOWN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL RICHARD HANSEN D.D.S. (OWNER)
(770) 622-1515
Entity
Organization
Contact information
Practice address
410 PEACHTREE PARKWAY, BUILDING 400, STE. 4250, CUMMING, GA 30041
(770) 887-8807
Mailing address
4330 JOHNS CREEK PARKWAY, STE. 100, SUWANEE, GA 30024
(770) 622-1515
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/08/2011
Last updated
02/09/2011
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