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General NPI Number Information
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NPI Number | 1063137925
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Entity Type | Organization
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Legal Business Name | GLEE DENTAL
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 3485 ACWORTH DUE WEST RD NW STE 160
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City | ACWORTH
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State | GA
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Zip | 30101-3870
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Country | US
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Telephone | 678-961-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 3485 ACWORTH DUE WEST RD NW STE 160
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City | ACWORTH
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State | GA
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Zip | 30101-3870
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Country | US
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Telephone | 678-961-3370
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | OLUBUNMI OSUNFISAN
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Credential |
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Telephone | 678-961-3370
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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 |
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License Number State |
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