Healthcare Provider Details

I. General information

NPI: 1518602937
Provider Name (Legal Business Name): GUARD 9 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 DULUTH HWY STE 1030
LAWRENCEVILLE GA
30043-5349
US

IV. Provider business mailing address

860 DULUTH HWY STE 1030
LAWRENCEVILLE GA
30043-5349
US

V. Phone/Fax

Practice location:
  • Phone: 770-682-7380
  • Fax:
Mailing address:
  • Phone: 770-682-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: TO NGA THI DINH
Title or Position: OWNER
Credential: DMD
Phone: 770-401-4719