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General NPI Number Information
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NPI Number | 1073894911
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Entity Type | Organization
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Legal Business Name | REGION DENTAL
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 2488 SCENIC HWY S
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City | SNELLVILLE
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State | GA
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Zip | 30078-5710
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Country | US
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Telephone | 770-736-2984
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Fax | 770-736-2987
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Provider Business Mailing Address
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Address Line | 2488 SCENIC HWY S
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City | SNELLVILLE
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State | GA
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Zip | 30078-5710
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Country | US
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Telephone | 770-736-2984
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Fax | 770-736-2987
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Authorized Official
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Title or Position | OWNER
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Name | JEWELL TOUSSIANT
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Credential |
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Telephone | 770-736-2984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | DN014167
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License Number State | TN
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