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General NPI Number Information
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NPI Number | 1043766322
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW DENTAL LLC
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 2320 BAKER RD NW SUITE B
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City | ACWORTH
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State | GA
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Zip | 30101-6842
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Country | US
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Telephone | 770-429-8989
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Fax | 770-429-1997
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Provider Business Mailing Address
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Address Line | 2320 BAKER ROAD SUITE B
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City | ACWORTH
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State | GA
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Zip | 30101
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Country | US
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Telephone | 770-429-8989
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Fax | 770-429-1997
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. HELEN DEANNE RHINESMITH
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Credential |
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Telephone | 770-429-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 9192
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License Number State | GA
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