Organization
LAIL FAMILY DENTISTRY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SLADE W LAIL (OWNER DENTIST)
(678) 772-5640
Entity
Organization
Contact information
Practice address
3415 HIGHWAY 120, DULUTH, GA 30096-3354
(770) 476-2400
(770) 623-1460
Mailing address
PO BOX 1476, DULUTH, GA 30096-0026
(770) 476-2400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538482377
LISA MOSS
GA
01
—
1790213825
DEVAN CALLAWAY
GA
01
—
1821263831
WALLACE LAIL
GA
01
—
1881981181
SWL DENTAL
GA
01
—
1902997109
SLADE LAIL
GA
Enumeration date
01/03/2020
Last updated
01/13/2020
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