Healthcare Provider Details

I. General information

NPI: 1265572226
Provider Name (Legal Business Name): GEORGE ROLAND BIEDERMAN JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BUFORD HWY SUITE T- 1
SUGAR HILL GA
30518-8721
US

IV. Provider business mailing address

1400 BUFORD HWY SUITE T- 1
SUGAR HILL GA
30518-8721
US

V. Phone/Fax

Practice location:
  • Phone: 770-945-1080
  • Fax: 770-945-1090
Mailing address:
  • Phone: 770-945-1080
  • Fax: 770-945-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10301
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: