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General NPI Number Information
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NPI Number | 1053034785
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SEDATION CENTER OF GA
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 8180 MALL PKWY STE 810
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City | LITHONIA
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State | GA
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Zip | 30038-6911
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Country | US
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Telephone | 470-395-2518
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Fax | 470-243-7395
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Provider Business Mailing Address
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Address Line | 8180 MALL PKWY STE 810
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City | LITHONIA
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State | GA
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Zip | 30038-6911
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Country | US
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Telephone | 470-395-2518
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Fax | 470-243-7395
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SERENTHES FIELDS
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Credential |
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Telephone | 678-599-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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