Organization
NORTHWEST ENDODONTIC SPECIALISTS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARDSON MICHAEL ODUM D.M.D. (PRESIDENT)
(770) 924-0423
Entity
Organization
Contact information
Practice address
271 HERITAGE WALK, WOODSTOCK, GA 30188-3876
(770) 924-0423
(770) 924-9222
Mailing address
271 HERITAGE WALK, WOODSTOCK, GA 30188-3876
(770) 924-0423
(770) 924-9222
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
10232, 10416
GA
Other
Enumeration date
03/30/2007
Last updated
08/22/2020
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