Organization
LIFETIME DENTAL GROUP LLC
Active
Other names
Gwinnett Place Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FABIOLA PALACIOS-BARRIONUEVO DDS (MEMBER)
(770) 842-4900
Entity
Organization
Contact information
Practice address
3796 SATELLITE BLVD, DULUTH, GA 30096-5699
(770) 476-4140
(770) 497-9435
Mailing address
3920 SHILOH RIDGE RUN, SUWANEE, GA 30024-6015
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN014333
GA
Other
Enumeration date
09/20/2011
Last updated
09/20/2011
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