Healthcare Provider Details

I. General information

NPI: 1154231447
Provider Name (Legal Business Name): CD VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 WILLEO RD STE 104
ROSWELL GA
30075-6773
US

IV. Provider business mailing address

9420 WILLEO RD STE 104
ROSWELL GA
30075-6773
US

V. Phone/Fax

Practice location:
  • Phone: 678-352-8108
  • Fax: 678-809-2971
Mailing address:
  • Phone: 678-352-8108
  • Fax: 678-809-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PRIYA A MADHIWALA
Title or Position: OWNER
Credential: DMD
Phone: 678-352-8108