Organization
CONYERS DENTURES & IMPLANT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON CLELAND FRASER JR. DMD (DENTIST)
(770) 483-4469
Entity
Organization
Contact information
Practice address
1916 IRIS DRIVE, SW, CONYERS, GA 30094
(770) 483-4469
(770) 922-0401
Mailing address
P.O. BOX 2213, PEACHTREE CITY, GA 30269
(770) 483-4469
(770) 922-0401
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN012684
GA
1223P0300X
Periodontics
Primary
DN012684
GA
Other
Enumeration date
10/10/2007
Last updated
05/02/2016
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