Healthcare Provider Details

I. General information

NPI: 1841454329
Provider Name (Legal Business Name): MARTIN P KRIEGER DDS AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CANTON RD NE SUITE D
MARIETTA GA
30060-8953
US

IV. Provider business mailing address

810 CANTON RD NE SUITE D
MARIETTA GA
30060-8953
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 Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN008049
License Number StateGA

VIII. Authorized Official

Name: MRS. SUSAN JEAN CHAMBERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 770-422-8264