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General NPI Number Information
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NPI Number | 1154017812
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Entity Type | Organization
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Legal Business Name | AVALON PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 04/14/2023
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 3480 PRESTON RIDGE RD STE 125
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City | ALPHARETTA
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State | GA
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Zip | 30005-5458
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Country | US
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Telephone | 770-993-9395
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Fax |
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Provider Business Mailing Address
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Address Line | 3480 PRESTON RIDGE RD STE 125
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City | ALPHARETTA
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State | GA
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Zip | 30005-5458
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Country | US
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Telephone | 770-993-9395
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Fax |
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. OHKYOUNG SARAH CHANG
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Credential | DDS
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Telephone | 917-450-8906
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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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