Healthcare Provider Details

I. General information

NPI: 1699143131
Provider Name (Legal Business Name): ATLANTA CENTER FOR ENDODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW SUITE 205
ATLANTA GA
30327-1610
US

IV. Provider business mailing address

3200 DOWNWOOD CIR NW SUITE 205
ATLANTA GA
30327-1610
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-5510
  • Fax:
Mailing address:
  • Phone: 404-351-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number011308
License Number StateGA

VIII. Authorized Official

Name: DR. MELANIE BURNS
Title or Position: PRESIDENT
Credential: D.M.D., M.P.H.
Phone: 404-351-5510