Organization
SQUARE ONE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SENGSOURIYA ANANTHASANE (DENTIST)
(770) 888-8295
Entity
Organization
Contact information
Practice address
3510 ROWE LANE, CUMMING, GA 30041
(770) 888-8295
Mailing address
5870 CHARLOTTE LN, SUITE 200, CUMMING, GA 30040-0316
(770) 888-8295
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN012307
GA
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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