MEDICARE: THE ART OF COSMETIC DENTISTRY, 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	:	1659668994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ART OF COSMETIC DENTISTRY, PC

Provider Business Mailing Address
First Line	:	3333 PIEDMONT RD NE
Second Line	:	TERMINUS 200, STE 130
City	:	ATLANTA
State	:	GA
Zip	:	30305-1712
Country	:	US
Telephone Number	:	404-846-6797
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 PIEDMONT RD NE
Second Line	:	TERMINUS 200, STE 130
City	:	ATLANTA
State	:	GA
Zip	:	30305-1712
Country	:	US
Telephone Number	:	404-846-6797
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNTS MANAGER
Name	:	JESSICA MARTIN
Credential	:
Telephone Number	:	770-591-7894

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	07/07/2011

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