Organization
ROYAL LAKES FAMILY AND COSMETIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGINALD DOUGLAS BOOKER DDS (OWNER/DENTIST)
(770) 531-3232
Entity
Organization
Contact information
Practice address
4005 WINDER HWY, SUITE 100, FLOWERY BRANCH, GA 30542-6564
(770) 531-3232
(770) 531-3238
Mailing address
4005 WINDER HWY, SUITE 100, FLOWERY BRANCH, GA 30542-6564
(770) 531-3232
(770) 531-3238
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN013464
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699711416
INDIVIDUAL NPI NUMBER
GA
Enumeration date
12/21/2009
Last updated
12/21/2009
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