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General NPI Number Information
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NPI Number | 1104250331
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Entity Type | Organization
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Legal Business Name | ALL FOR KIDS DENTAL GROUP, LLC
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 08/23/2013
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Provider Practice Location Address
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Address Line | 4115 TATE ST NE
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City | COVINGTON
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State | GA
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Zip | 30014-2554
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Country | US
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Telephone | 770-784-7099
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Fax | 770-784-5283
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Provider Business Mailing Address
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Address Line | 4115 TATE ST NE
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City | COVINGTON
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State | GA
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Zip | 30014-2554
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Country | US
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Telephone | 770-784-7099
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Fax | 770-784-5283
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. ADRIAN MILLER
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Credential | DDS
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Telephone | 770-784-7099
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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 | DN013969
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License Number State | GA
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