Organization
ODP OF NORTHWEST GEORGIA PC
Active
Other names
Cedarcrest Childrens Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE CARIDE (CREDENTIALING MANAGER)
(727) 784-2721
Entity
Organization
Contact information
Practice address
2155 CEDARCREST RD, ACWORTH, GA 30101-6274
(770) 439-9119
Mailing address
2300 LAKEVIEW PKWY STE 250, ALPHARETTA, GA 30009-3954
(470) 207-3264
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
03/09/2023
Last updated
01/21/2025
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