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Organization

MICHELLE GWYN DDS, PC

Active
Other names
Perfect Portrait Family Dentistry
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MICHELLE SANDRA GWYN DDS (OWNER)
(678) 304-8408
Entity
Organization

Contact information

Practice address
5040 BILL GARDNER PKWY STE 300, LOCUST GROVE, GA 30248-3758
(678) 304-8408
(689) 304-8409
Mailing address
5040 BILL GARDNER PKWY STE 300, LOCUST GROVE, GA 30248-3758
(678) 304-8408
(689) 304-8409

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN013195
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
675686848C
GA
Enumeration date
11/29/2016
Last updated
11/29/2016
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