Organization
GEORGIA DENTAL PROFESSIONALS, PC
Active
Parent organization
GEORGIA DENTAL PROFESSIONALS, PC
Other names
Olde Mill Family Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Authorized official
KENDRA WALKER (CREDENTIALING COORDINATOR)
(217) 540-8312
Entity
Organization
Contact information
Practice address
3101 ROSWELL RD, SUITE 164, MARIETTA, GA 30062-7621
(678) 310-0330
Mailing address
3101 ROSWELL RD, SUITE 164, MARIETTA, GA 30062-7621
(678) 310-0330
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/29/2015
Last updated
11/04/2015
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