MEDICARE: FEATHER TOUCH DENTAL CARE 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	DN013903	GA
2	1223G0001X	General Practice Dentistry	7099	GA

General Provider Information

NPI Number	:	1497007991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEATHER TOUCH DENTAL CARE LLC

Provider Business Mailing Address
First Line	:	1175 PEACHTREE ST NE
Second Line	:	SUITE 1204
City	:	ATLANTA
State	:	GA
Zip	:	30361-3528
Country	:	US
Telephone Number	:	404-892-2097
Fax Number	:	866-318-6029

Provider Business Practice Location Address
First Line	:	1175 PEACHTREE ST NE
Second Line	:	SUITE 1204
City	:	ATLANTA
State	:	GA
Zip	:	30361-3528
Country	:	US
Telephone Number	:	404-892-2097
Fax Number	:	866-318-6029

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MS. CARLISSA MANNING
Credential	:
Telephone Number	:	404-879-6634

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	10/08/2012

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