Healthcare Provider Details

I. General information

NPI: 1194833772
Provider Name (Legal Business Name): MARTIN P KRIEGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARTIN PHILIP KRIEGER DDS

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CANTON RD STE D
MARIETTA GA
30060
US

IV. Provider business mailing address

810 CANTON RD STE D
MARIETTA GA
30060
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-8264
  • Fax: 770-422-4051
Mailing address:
  • Phone: 770-422-8264
  • Fax: 770-422-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number008049
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: