Organization
FABULOUS DENTISTRY AND ORTHODONTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUAN J SOLANO D.D.S. (PRESIDENT)
(678) 325-3970
Entity
Organization
Contact information
Practice address
950 INDIAN TRL RD NW, SUITE 3-G, LILBURN, GA 30047-1721
(678) 325-3970
(678) 325-3971
Mailing address
950 INDIAN TRL RD NW, SUITE 3-G, LILBURN, GA 30047-1721
(678) 325-3970
(678) 325-3971
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502321377B
—
GA
Enumeration date
03/25/2008
Last updated
02/12/2024
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