Organization
CREEKSIDE ORAL SURGERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NKEMAKONAM EGOLUM DDS (OWNER)
(770) 764-0840
Entity
Organization
Contact information
Practice address
10700 MEDLOCK BRIDGE RD STE 204, JOHNS CREEK, GA 30097-8455
(770) 764-0840
Mailing address
10700 MEDLOCK BRIDGE RD STE 204, JOHNS CREEK, GA 30097-8455
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
10/12/2023
Last updated
10/12/2023
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