Organization
PDA ORTHO SPECIALTY OF GEORGIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN HOWARD MA (CREDENTIALING SPECIALIST)
(724) 698-2029
Entity
Organization
Contact information
Practice address
3450 COBB PKWY NW STE 160, ACWORTH, GA 30101-8379
(770) 222-2322
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
02/01/2019
Last updated
02/01/2019
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