Organization
GOVERNMENT DENTAL LLC
Active
Other names
Elite Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FRANCINE WEATHERSPOON DIXON (CEO)
(865) 256-2638
Entity
Organization
Contact information
Practice address
7218 HIGHWAY 85, RIVERDALE, GA 30274-2908
(404) 593-3404
(404) 228-9673
Mailing address
7218 HIGHWAY 85, RIVERDALE, GA 30274-2908
(404) 593-3404
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14566GA
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003180284A
—
GA
Enumeration date
04/06/2016
Last updated
05/23/2020
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