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Organization

CANTON DENTAL, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LOGAN V GORDON (BUSINESS MANAGER)
(770) 479-5425
Entity
Organization

Contact information

Practice address
230 RIVERSTONE PKWY STE A, CANTON, GA 30114-6414
(770) 479-5425
Mailing address
230 RIVERSTONE PKWY STE A, CANTON, GA 30114-6414
(770) 479-5425

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
GA012160
GA

Other

Enumeration date
10/01/2009
Last updated
10/01/2009
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