Organization
DECATUR DENTAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RESA JOHNELLE ROBERTS (ORGANIZER)
(404) 556-1393
Entity
Organization
Contact information
Practice address
3660 FLAT SHOALS RD, SUITE 100, DECATUR, GA 30034-1632
(404) 243-0217
(404) 243-9313
Mailing address
3660 FLAT SHOALS RD, SUITE 100, DECATUR, GA 30034-1632
(404) 243-0217
(404) 243-9313
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN010168
GA
Other
Enumeration date
09/01/2010
Last updated
09/21/2011
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