Organization
CHILDRENS DENTISTRY OF WOODSTOCK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN SMITH (CONTROLLER)
(678) 445-5444
Entity
Organization
Contact information
Practice address
2230 TOWNE LAKE PKWY, BLDG 1300 STE 100, WOODSTOCK, GA 30189
(678) 455-5444
(678) 455-5552
Mailing address
PO BOX 195, WOODSTOCK, GA 30188
(678) 445-5444
(678) 445-5552
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
GA
Other
Enumeration date
12/06/2006
Last updated
08/22/2020
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