Organization
METRO DENTAL @ NORTHLAKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BETTYE G CULVER (PRACTICE ADMINISTRATOR)
(404) 761-8455
Entity
Organization
Contact information
Practice address
2258 NORTHLAKE PKWY, SUITE 200, TUCKER, GA 30084-4019
(678) 937-9601
(678) 937-9602
Mailing address
2258 NORTHLAKE PKWY, SUITE 200, TUCKER, GA 30084-4019
(678) 937-9601
(678) 937-9602
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13196
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154490639
—
GA
Enumeration date
02/06/2009
Last updated
02/06/2009
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