Healthcare Provider Details

I. General information

NPI: 1629190335
Provider Name (Legal Business Name): ECONOMY DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 HIGHWAY 138 SW
RIVERDALE GA
30296-1572
US

IV. Provider business mailing address

948 HIGHWAY 138 SW
RIVERDALE GA
30296-1572
US

V. Phone/Fax

Practice location:
  • Phone: 770-909-0070
  • Fax: 770-909-0060
Mailing address:
  • Phone: 770-909-0070
  • Fax: 770-909-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1223G0001X
License Number StateGA

VIII. Authorized Official

Name: DR. ROY CHARLES BELL
Title or Position: DENTIST
Credential: D.D.S J.D. P.C
Phone: 770-909-0070