Organization
EAST ATLANTA PEDIATRIC DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA JORDAN DMD (DENTIST/OWNER)
(404) 243-0929
Entity
Organization
Contact information
Practice address
2646 GRESHAM RD SE, ATLANTA, GA 30316-4148
(404) 243-0929
(404) 243-0928
Mailing address
2646 GRESHAM RD SE, ATLANTA, GA 30316-4148
(404) 243-0929
(404) 243-0928
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012645
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780888693
NPPES
GA
01
—
DN012645
DENTAL LICENSE
GA
Enumeration date
12/17/2014
Last updated
12/17/2014
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