MEDICARE: DENTISTS OF CHAMBLEE, PC

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	:	1346785029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTS OF CHAMBLEE, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	5001 PEACHTREE BLVD
Second Line	:	SUITE 510
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-2719
Country	:	US
Telephone Number	:	404-902-5820
Fax Number	:	404-418-6396

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATIE L MCCANN
Credential	:	DDS
Telephone Number	:	404-902-5820

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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