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NPI Code Detail

MEDICARE: NORTH ROAD FAMILY DENTAL PC

MEDICARE: NORTH ROAD FAMILY DENTAL 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
1122300000XDentist
21223E0200XEndodontics
31223P0300XPeriodontics
41223S0112XOral and Maxillofacial Surgery (Dentist)
51223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1982299764
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH ROAD FAMILY DENTAL PC
Provider Business Mailing Address
First Line : 296 S MAIN ST STE 300
Second Line :
City : ALPHARETTA
State : GA
Zip : 30009-1973
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2175 NORTH RD
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2630
Country : US
Telephone Number : 770-972-2000
Fax Number :
Authorized Official
Title or Position : SECRETARY
Name : BEN CUTLER
Credential :
Telephone Number : 607-743-9474
Provider Enumeration Date : 03/04/2021
Last Update Date : 05/12/2022

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Directions to “NORTH ROAD FAMILY DENTAL PC ” Practice Location

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