MEDICARE: METADENT CLUB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1225981384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METADENT CLUB LLC

Provider Business Mailing Address
First Line	:	3535 ROSWELL RD STE 53
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-8828
Country	:	US
Telephone Number	:	770-615-6155
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 ROSWELL RD STE 53
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-8828
Country	:	US
Telephone Number	:	770-615-6155
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	PAUL DOMINIQUE
Credential	:	DMD
Telephone Number	:	770-615-6155

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

Similar Medicare Providers

1093828238 — DR. ASHISH C PATEL DDS
Practice Location Address:

3535 ROSWELL RD STE 55
MARIETTA, GA
30062-8828

Practice Phone: 770-321-5558
Practice Fax:

1043378342 — DR. WILLIAM BRIAN HAWKINS D.D.S.,M.A.G.D.
Practice Location Address:

3535 ROSWELL RD STE 56
MARIETTA, GA
30062-8828

Practice Phone: 770-977-5647
Practice Fax:

1285139915 — DR. DANIELLE VOLANTE BAUMAN DMD
Practice Location Address:

3535 ROSWELL RD STE 55
MARIETTA, GA
30062-8828

Practice Phone: 770-321-5558
Practice Fax:

1790282341 — DAHLIA LEVINE
Practice Location Address:

3535 ROSWELL RD STE 55
MARIETTA, GA
30062-8828

Practice Phone: 770-321-5558
Practice Fax:

1144828765 — SHARMA ORTHODONTICS LLC
Practice Location Address:

3535 ROSWELL RD STE 53
MARIETTA, GA
30062-8828

Practice Phone: 404-433-1317
Practice Fax:

1689343279 — COBB ROOT CANALS
Practice Location Address:

3535 ROSWELL RD STE 56
MARIETTA, GA
30062-8828

Practice Phone: 678-996-6949
Practice Fax: 470-689-3976

Directions to “METADENT CLUB LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.