Organization
ROSWELL PEDIATRIC DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VISHANT NATH DMD (OWNER/DENTIST)
(678) 763-2600
Entity
Organization
Contact information
Practice address
10930 CRABAPPLE RD STE 106, ROSWELL, GA 30075-5825
(678) 763-2600
(678) 893-0459
Mailing address
10930 CRABAPPLE RD STE 106, ROSWELL, GA 30075-5825
(678) 763-2600
(678) 893-0459
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN013057
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
761564386
—
GA
Enumeration date
04/22/2008
Last updated
04/22/2008
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