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General NPI Number Information
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NPI Number | 1023357464
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Entity Type | Organization
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Legal Business Name | BOOKER ORAL SURGERY & IMPLANT CENTER PC
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 02/21/2014
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Provider Practice Location Address
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Address Line | 335 PEACHTREE INDUSTRIAL BLVD SUITE 2210
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City | SUWANEE
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State | GA
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Zip | 30024-3756
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Country | US
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Telephone | 770-932-8869
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Fax | 770-932-8870
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Provider Business Mailing Address
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Address Line | 335 PEACHTREE INDUSTRIAL BLVD SUITE 2210
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City | SUWANEE
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State | GA
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Zip | 30024-3756
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Country | US
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Telephone | 770-932-8869
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Fax | 770-932-8870
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | STACEY C NEWTON-BOOKER
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Credential | DDS
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Telephone | 770-932-8869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN012963
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License Number State | GA
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