Organization
SACRED DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AGATHA NWIZU (DENTIST)
(770) 474-9202
Entity
Organization
Contact information
Practice address
1360 DOGWOOD DRIVE, CONYERS, GA 30013
(770) 474-9202
Mailing address
1360 DOGWOOD DR SE, CONYERS, GA 30013-5075
(770) 474-9202
(770) 474-9842
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN013176
GA
Other
Enumeration date
06/15/2012
Last updated
06/15/2012
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