Organization
COSMETIC AND RESTORATIVE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSANNA MASCIADRI D.M.D (OWNER)
(706) 227-2502
Entity
Organization
Contact information
Practice address
1175 OGLETHORPE AVE, ATHENS, GA 30606-2129
(706) 227-2502
(706) 227-0207
Mailing address
1175 OGLETHORPE AVE, ATHENS, GA 30606-2129
(706) 227-2502
(706) 227-0207
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
BM3609596
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00723401A
—
GA
01
—
983777
UNITED CONCORDIA
GA
Enumeration date
12/26/2006
Last updated
08/22/2020
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