Individual
DANIEL TESFA REDIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1849 HWY 138, RIVERDALE, GA 30296
(770) 996-5850
(770) 996-5851
Mailing address
1849 HWY 138, RIVERDALE, GA 30296
(770) 996-5850
(770) 996-5851
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN012618
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN012618
GA DENTAL LICENSE
GA
Enumeration date
09/15/2006
Last updated
03/07/2023
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