Organization
MALL OF GEORGIA DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON VANCIL (OFFICE MANAGER)
(678) 714-6343
Entity
Organization
Contact information
Practice address
1905 MALL OF GEORGIA BLVD STE 1, BUFORD, GA 30519
(678) 714-6343
(678) 714-6345
Mailing address
1905 MALL OF GEORGIA BLVD STE 1, BUFORD, GA 30519
(678) 714-6343
(678) 714-6345
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
012441
GA
261QD0000X
Dental Clinic/Center
012441
GA
Other
Enumeration date
06/13/2016
Last updated
05/02/2018
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