Healthcare Provider Details

I. General information

NPI: 1609092279
Provider Name (Legal Business Name): AMANDA W. CONTI, D.M.D, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WALNUT GROVE RD SE
CARTERSVILLE GA
30120-6431
US

IV. Provider business mailing address

300 WALNUT GROVE RD SE
CARTERSVILLE GA
30120-6431
US

V. Phone/Fax

Practice location:
  • Phone: 770-727-2211
  • Fax: 770-727-2213
Mailing address:
  • Phone: 770-727-2211
  • Fax: 770-727-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11537
License Number StateGA

VIII. Authorized Official

Name: DR. AMANDA W. CONTI
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 770-727-2211