Organization
PROFESSIONAL DENTAL ALLIANCE OF CONYERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA BARRETTE (CREDENTIALING SPECIALIST)
(724) 698-2997
Entity
Organization
Contact information
Practice address
1820 GEORGIA HIGHWAY 20 SE STE 148, CONYERS, GA 30013-2076
(770) 922-4375
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/23/2019
Last updated
05/23/2019
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