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General NPI Number Information
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NPI Number | 1003492224
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Entity Type | Organization
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Legal Business Name | DREAM PEDIATRIC DENTISTRY AND ORTHODONTICS, LLC
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 2143 NEWNAN CROSSING BLVD E STE 100
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City | NEWNAN
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State | GA
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Zip | 30265-2406
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Country | US
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Telephone | 470-541-2426
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Fax |
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Provider Business Mailing Address
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Address Line | 2143 NEWNAN CROSSING BLVD E STE 100
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City | NEWNAN
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State | GA
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Zip | 30265-2406
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Country | US
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Telephone | 470-541-2426
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MALLORY DAWSON
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Credential | DMD
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Telephone | 478-955-6125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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