Organization
MOUTHPEACE DENTAL 4, LLC
Active
Other names
MouthPeace Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SYRETTA WELLS DDS (OWNER /DENTIST)
(312) 371-1423
Entity
Organization
Contact information
Practice address
541 FOREST PKWY STE 18, FOREST PARK, GA 30297-6110
(404) 228-6801
Mailing address
2149 BRANNEN RD SE, ATLANTA, GA 30316-4117
(312) 371-1423
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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