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Organization

GRACE PEDIATRIC DENTAL CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TABITHA IKPECHUKWU EFOBI (OWNER)
(757) 831-6852
Entity
Organization

Contact information

Practice address
2115 LOGANVILLE HWY STE 101, GRAYSON, GA 30017-1771
(470) 508-0125
Mailing address
2115 LOGANVILLE HWY STE 101, GRAYSON, GA 30017-1771
(470) 508-0125

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
11/03/2021
Last updated
11/03/2021
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