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Organization

VILLA RICA FAMILY DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JAMEY CHANG (DENTIST)
(770) 459-4131
Entity
Organization

Contact information

Practice address
865 S CARROLL RD STE C, VILLA RICA, GA 30180-7056
(770) 459-4131
(770) 459-4132
Mailing address
865 S CARROLL RD STE C, VILLA RICA, GA 30180-7056
(770) 459-4131
(770) 459-4132

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN0112559
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
129648207A
GA
Enumeration date
09/08/2008
Last updated
09/08/2008
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