Organization
KENNESAW MODERN DENTISTRY, PC
Active
Other names
Kennesaw Modern Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE HOUSTON DMD (OWNER)
(678) 832-0527
Entity
Organization
Contact information
Practice address
1125 ERNEST W BARRETT PKWY NW BLDG 200, KENNESAW, GA 30144-4535
(678) 832-0527
(678) 835-9729
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
(714) 845-8500
(303) 952-0892
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
03/03/2022
Last updated
04/26/2022
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