Individual
MONICA S BLAYLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
309 PIRKLE FERRY RD STE C100, CUMMING, GA 30040-2549
(770) 205-9226
(770) 205-2278
Mailing address
309 PIRKLE FERRY RD STE C100, CUMMING, GA 30040-2549
(770) 205-9226
(770) 205-2278
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11514
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11514
STATE DENTAL LICENSE
GA
Enumeration date
11/01/2006
Last updated
07/08/2007
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