Organization
WENDY MEDDERS MACKE DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WENDY MEDDERS MACKE DMD (PRESIDENT)
(678) 908-5866
Entity
Organization
Contact information
Practice address
76 NORCROSS ST, ROSWELL, GA 30075-3866
(770) 993-0265
(770) 998-7307
Mailing address
4240 ANCROFT CIR, NORCROSS, GA 30092-2664
(678) 908-5866
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012427
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831282193
INDIVIDUAL NPI #
GA
Enumeration date
09/26/2008
Last updated
09/26/2008
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