Organization
MOUTHPEACE DENTAL LLC
Active
Parent organization
MOUTHPEACE DENTAL LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOUTHPEACE DENTAL LLC
Authorized official
SYRETTA WELLS DDS (DENTIST)
(312) 371-1423
Entity
Organization
Contact information
Practice address
1050 MARIETTA ST NW, SUITE A, ATLANTA, GA 30318-5522
(312) 371-1423
Mailing address
1050 MARIETTA ST NW, SUITE A, ATLANTA, GA 30318-5522
(312) 371-1423
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN013505
GA
1223G0001X
General Practice Dentistry
DN013505
GA
1223P0700X
Prosthodontics
DN013505
GA
Other
Enumeration date
11/07/2014
Last updated
11/07/2014
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