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Organization

MOUTHPEACE DENTAL 5 LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SYRETTA WELLS DDS (PRESIDENT)
(312) 371-1423
Entity
Organization

Contact information

Practice address
2655 S COBB DR SE, SMYRNA, GA 30080-1873
(312) 371-1423
Mailing address
PO BOX 950008, ATLANTA, GA 30377-2008
(312) 371-1423

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
03/12/2025
Last updated
03/12/2025
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