Organization
JUDGE, LISA MARIA DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M JUDGE D.D.S. (DOCTOR OWNER)
(770) 541-0101
Entity
Organization
Contact information
Practice address
1230 POWERS FERRY RD SE, SUITE #6, MARIETTA, GA 30067-5495
(770) 541-0101
(770) 541-0102
Mailing address
1230 POWERS FERRY RD SE, SUITE #6, MARIETTA, GA 30067-5495
(770) 541-0101
(770) 541-0102
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
4430
LA
1223G0001X
General Practice Dentistry
Primary
DN011180
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00764112B
—
GA
Enumeration date
01/22/2007
Last updated
06/16/2008
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