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General NPI Number Information
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NPI Number | 1114405511
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Entity Type | Organization
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Legal Business Name | SPOTLIGHT DENTAL ALPHARETTA
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 3180 N POINT PKWY STE 522
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City | ALPHARETTA
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State | GA
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Zip | 30005-4569
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Country | US
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Telephone | 470-719-5181
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Fax |
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Provider Business Mailing Address
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Address Line | 3180 N POINT PKWY STE 522
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City | ALPHARETTA
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State | GA
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Zip | 30005-4569
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Country | US
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Telephone | 470-719-5181
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GUSTAVE JOSEPH PELUSO
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Credential | DMD
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Telephone | 404-405-7756
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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 | DN011882
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License Number State | GA
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