Organization
GEORGIA DENTAL PROFESSIONALS, PC
Active
Parent organization
GEORGIA DENTAL PROFESSIONALS, PC
Other names
Shadow Brook Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
GEORGIA DENTAL PROFESSIONALS, PC
Authorized official
KENDRA WALKER (CREDENTIALING SUPERVISOR)
(217) 540-8312
Entity
Organization
Contact information
Practice address
3320 LAWRENCEVILLE SUWANEE RD, SUITE 2F, SUWANEE, GA 30024-6542
(678) 546-4000
(678) 546-4005
Mailing address
3320 LAWRENCEVILLE SUWANEE RD, SUITE 2F, SUWANEE, GA 30024-6542
(678) 546-4000
(678) 546-4005
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/13/2008
Last updated
04/03/2017
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