Organization
TEBO DENTISTRY FOR KIDS DACULA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFFER CONNOR (ADMINISTRATIVE ASSISTANT)
(678) 990-6331
Entity
Organization
Contact information
Practice address
1152 AUBURN RD, BUILDING 1, SUITE 101, DACULA, GA 30019-5444
(770) 925-3300
Mailing address
PO BOX 1953, LILBURN, GA 30048-1953
(770) 925-3300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN009113
—
1223G0001X
General Practice Dentistry
DN011863
GA
1223G0001X
General Practice Dentistry
DN013919
GA
1223G0001X
General Practice Dentistry
DN013997
GA
1223P0221X
Pediatric Dentistry
Primary
DN009113
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033449517
NPI
GA
01
—
124533238
NPI
—
01
—
1245432004
NPI
GA
01
—
1730316597
NPI
GA
Enumeration date
07/02/2012
Last updated
07/02/2012
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