Organization
CANTON MARKETPLACE DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
POYA M MOGHADAM (OWNER)
(678) 880-0087
Entity
Organization
Contact information
Practice address
1810 CUMMING HWY STE 900, CANTON, GA 30115-2999
(770) 780-2465
(678) 880-0059
Mailing address
1810 CUMMING HWY STE 900, CANTON, GA 30115-2999
(678) 880-0087
(678) 880-0059
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/21/2018
Last updated
12/21/2018
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