Organization
LITTLE PEACHES PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARISSE CASWELL DMD (OWNER)
(770) 632-7090
Entity
Organization
Contact information
Practice address
120 HANDLEY RD, SUITE 210, TYRONE, GA 30290-2177
(770) 632-7090
(770) 632-7075
Mailing address
120 HANDLEY RD, SUITE 210, TYRONE, GA 30290-2177
(770) 632-7090
(770) 632-7075
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN013163
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
773054619G
—
GA
05
—
773054619H
—
GA
Enumeration date
06/17/2016
Last updated
06/17/2016
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