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Organization

NORTHWEST ENDODONTIC SPECIALISTS, P.C.

Active
Other names
Canton office
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RICHARDSON MICHAEL ODUM DMD (PRESIDENT)
(678) 493-6693
Entity
Organization

Contact information

Practice address
2205 RIVERSTONE BLVD, SUITE 205, CANTON, GA 30114-5227
(678) 493-6693
(678) 493-6694
Mailing address
2205 RIVERSTONE BLVD, SUITE 205, CANTON, GA 30114-5227
(678) 493-6693
(678) 493-6694

Taxonomy

Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
10232, 10416
GA

Other

Enumeration date
03/24/2008
Last updated
03/24/2008
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