Individual
DR. MARTINO SYLVESTER FAGGIONI JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1462 MONTREAL RD, SUITE 211, TUCKER, GA 30084-6929
(770) 038-1848
(770) 938-1856
Mailing address
1462 MONTREAL ROAD, SUITE 211, TUCKER, GA 30084-6931
(770) 038-1848
(770) 938-1856
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7303
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000202243B
—
GA
01
—
100190
AVESIS PROVIDER NUMBER
GA
01
—
9180034
DORAL DENTAL USA PROVIDER
GA
Enumeration date
07/29/2006
Last updated
07/09/2007
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