Organization
THE CHILDREN'S DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IDA LYNN ROSE-MIZE DDS (PEDIATRIC DENTIST)
(770) 941-8802
Entity
Organization
Contact information
Practice address
560 THORNTON RD, SUITE 203, LITHIA SPRINGS, GA 30122-1655
(770) 234-4859
Mailing address
560 THORNTON RD, SUITE 203, LITHIA SPRINGS, GA 30122-1655
(770) 234-4859
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012631
GA
Other
Enumeration date
02/03/2007
Last updated
08/22/2020
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