Healthcare Provider Details

I. General information

NPI: 1265454102
Provider Name (Legal Business Name): CHOICE DENTAL P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4484 JIMMY LEE SMITH PKWY
HIRAM GA
30141-2737
US

IV. Provider business mailing address

4484 JIMMY LEE SMITH PKWY
HIRAM GA
30141-2737
US

V. Phone/Fax

Practice location:
  • Phone: 770-222-7818
  • Fax: 770-222-7828
Mailing address:
  • Phone: 770-222-7818
  • Fax: 770-222-7828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number012443
License Number StateGA

VIII. Authorized Official

Name: DR. OLAJUMOKE ADEDOYIN
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 404-966-7515