Organization
ASSISTED DENTAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA FOUNTAIN (MANAGING PARTNER)
(470) 589-9292
Entity
Organization
Contact information
Practice address
2070 LEE PETERS RD, LOGANVILLE, GA 30052-4193
(470) 589-9292
Mailing address
5885 CUMMING HWY STE 108199, SUGAR HILL, GA 30518-5765
(470) 589-9292
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN011027
GEORGIA BOARD OF DENTISTRY
GA
01
—
DN012292
DENTAL LICENSE
GA
Enumeration date
04/27/2022
Last updated
04/27/2022
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