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General NPI Number Information
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NPI Number | 1023135738
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Entity Type | Organization
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Legal Business Name | MAGUALIE J. WOOLLERY, D.M.D., P.C.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 06/09/2012
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Provider Practice Location Address
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Address Line | 7760 HAMPTON PL BUILDING 6
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City | LOGANVILLE
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State | GA
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Zip | 30052-6770
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Country | US
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Telephone | 678-639-0080
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Fax | 678-639-0088
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Provider Business Mailing Address
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Address Line | 7760 HAMPTON PL BUILDING 6
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City | LOGANVILLE
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State | GA
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Zip | 30052-6770
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Country | US
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Telephone | 678-639-0080
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Fax | 678-639-0088
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAGUALIE JOSEPH WOOLLERY
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Credential | D.M.D.
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Telephone | 678-639-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN012142
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License Number State | GA
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