Organization
IT'S A SMALL WORLD CHILDREN'S DENTISTRY
Active
Parent organization
GEORGIA DENTAL PROFESSIONALS, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Authorized official
KENDRA WALKER (CREDENTAILING COORDINATOR)
(217) 540-8312
Entity
Organization
Contact information
Practice address
2680 HIGHWAY 34 EAST, NEWMAN, GA 30265-1330
(770) 502-9733
(770) 502-9758
Mailing address
2680 HIGHWAY 34 EAST, NEWNAN, GA 30265-1330
(770) 502-9733
(770) 502-9758
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN011741
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000753871
—
GA
Enumeration date
05/17/2007
Last updated
07/17/2015
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