Organization
HERRIN CPDS PC
Active
Other names
Centers for Pediatric Dental Sedation
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS QURAN POLK MD (PRACTICE MANAGER)
(404) 403-4567
Entity
Organization
Contact information
Practice address
1571 PHOENIX BLVD STE 8, COLLEGE PARK, GA 30349-5536
(844) 682-4737
(404) 521-4044
Mailing address
PO BOX 370160, DECATUR, GA 30037-0160
(404) 403-4567
(404) 521-4044
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
DN013021
GA
1223P0221X
Pediatric Dentistry
Primary
DN014185
GA
1223P0221X
Pediatric Dentistry
DN014898
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003198439A
—
GA
Enumeration date
12/14/2017
Last updated
03/17/2018
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