Organization
CHILDREN AND TEEN DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER JORDAN ROGERS (CREDENTIALING SPECIALIST)
(470) 801-4637
Entity
Organization
Contact information
Practice address
285 ELM ST, CUMMING, GA 30040-8233
(770) 744-4581
Mailing address
2300 LAKEVIEW PKWY STE 250, ALPHARETTA, GA 30009-3954
(470) 750-4866
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
011988
GA
Other
Enumeration date
01/08/2015
Last updated
08/03/2026
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