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General NPI Number Information
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NPI Number | 1013132372
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Entity Type | Organization
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Legal Business Name | GREENLEA DENTAL CENTER PC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6740 SHANNON PKWY STE 2
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City | UNION CITY
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State | GA
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Zip | 30291-2058
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Country | US
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Telephone | 770-306-2996
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Fax | 770-306-0004
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Provider Business Mailing Address
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Address Line | 6740 SHANNON PKWY STE 2
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City | UNION CITY
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State | GA
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Zip | 30291-2058
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Country | US
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Telephone | 770-306-2996
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Fax | 770-306-0004
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JUDY TAYLOR
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Credential | DDS
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Telephone | 770-306-2996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | GA10999
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License Number State | GA
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