Individual
ANTWAN LONDELL TREADWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1790 MULKEY RD, SUITE 3A, AUSTELL, GA 30106-1122
(770) 941-2476
(770) 941-5710
Mailing address
1790 MULKEY RD, SUITE 3A, AUSTELL, GA 30106-1122
(770) 941-2476
(770) 941-5710
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12209
GA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN13765
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000849439B
—
GA
05
—
000849439C
—
GA
Enumeration date
08/16/2006
Last updated
07/08/2007
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