MEDICARE: MORROW DENTAL CENTER, 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	122300000X	Dentist	011936	GA
2	122300000X	Dentist	011920	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396939427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORROW DENTAL CENTER, LLC

Provider Business Mailing Address
First Line	:	6452 S LEE ST
Second Line	:	SUITE 7
City	:	MORROW
State	:	GA
Zip	:	30260-1771
Country	:	US
Telephone Number	:	678-422-6500
Fax Number	:	678-422-6588

Provider Business Practice Location Address
First Line	:	6452 S LEE ST
Second Line	:	SUITE 7
City	:	MORROW
State	:	GA
Zip	:	30260-1771
Country	:	US
Telephone Number	:	678-422-6500
Fax Number	:	678-422-6588

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CHI TRUC HUYNH
Credential	:	DDS
Telephone Number	:	678-422-6500

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	08/31/2007

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Directions to “MORROW DENTAL CENTER, LLC ” Practice Location

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