Organization
GWINNETT GENERAL DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA LONG (OFFICE MANAGER)
(770) 978-3292
Entity
Organization
Contact information
Practice address
3100 FIVE FORKS TRICKUM RD SW, SUITE 201, LILBURN, GA 30047-1890
(770) 978-3292
Mailing address
3100 FIVE FORKS TRICKUM RD SW, SUITE 201, LILBURN, GA 30047-1890
(770) 978-3292
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
011818
GA
Other
Enumeration date
06/23/2008
Last updated
06/23/2008
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