Individual
PAGE P BARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1024 MARKET PLACE BLVD, CUMMING, GA 30041-7921
(770) 844-6771
(770) 844-6686
Mailing address
4947 FAIRHAVEN WAY NE, ROSWELL, GA 30075-6110
(404) 272-2512
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN010757
GA
1223G0001X
General Practice Dentistry
DN010757
GA
1223P0300X
Periodontics
Primary
DN010757
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00882934D
—
GA
Enumeration date
07/31/2006
Last updated
08/04/2015
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