Individual
BRAD WARREN ROEHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
435 ARROWHEAD BLVD, JONESBORO, GA 30236-1219
(770) 478-8400
(770) 473-8766
Mailing address
295 COUNTRY CLUB DR, STOCKBRIDGE, GA 30281-7350
(770) 473-1350
(770) 692-0098
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012958
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280155184B
—
GA
Enumeration date
07/26/2006
Last updated
08/24/2012
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