Organization
GEORGIA DENTAL PROFESSIONALS, PC
Active
Parent organization
GEORGIA DENTAL PROFESSIONALS, PC
Other names
Kennesaw Complete Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Authorized official
TABATHA LEMKE (CREDENTIALING COORDINATOR)
(217) 540-6078
Entity
Organization
Contact information
Practice address
1200 ERNEST W BARRETT PKWY NW STE 200, KENNESAW, GA 30144-4513
(678) 354-0079
Mailing address
1200 ERNEST W BARRETT PKWY NW STE 200, KENNESAW, GA 30144-4513
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/11/2021
Last updated
05/11/2021
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