Organization
FRED F WORRALL, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED FRANCIS WORRALL II DDS (OWNER)
(770) 792-2300
Entity
Organization
Contact information
Practice address
707 WHITLOCK AVE SW STE D29, MARIETTA, GA 30064-3083
(770) 792-2300
(770) 792-2436
Mailing address
707 WHITLOCK AVE SW STE D29, MARIETTA, GA 30064-3083
(770) 792-2300
(770) 792-2436
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
011402
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN011402
GA BOARD OF DENTISTRY LIC
GA
Enumeration date
04/04/2007
Last updated
08/22/2020
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