Organization
TREMONT ROAD DENTAL, PC
Active
Other names
Spencer Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JACOMINO (DIRECTOR OF PAYOR RELATIONS)
(770) 916-5036
Entity
Organization
Contact information
Practice address
5002 AIRPORT RD NW, UNIT 130, ROANOKE, VA 24012-1607
(770) 916-5031
Mailing address
1090 NORTHCHASE PKWY SE, SUITE 150, MARIETTA, GA 30067-6405
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
08/22/2014
Last updated
05/27/2022
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