Organization
FAMILY DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA MCINTYRE DDS (OWNER)
(678) 565-1985
Entity
Organization
Contact information
Practice address
12 ROUNTREE RD, RIVERDALE, GA 30274-4036
(678) 913-4912
Mailing address
31 HIGHWAY 138 W, SUITE 160, STOCKBRIDGE, GA 30281-4320
(678) 913-4912
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012467
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000925735H
—
GA
Enumeration date
03/25/2015
Last updated
03/25/2015
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