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General NPI Number Information
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NPI Number | 1154712362
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Entity Type | Organization
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Legal Business Name | GRINS & GIGGLES PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 190 CURTIS PKWY NE SUITE B
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City | CALHOUN
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State | GA
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Zip | 30701-2057
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Country | US
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Telephone | 706-602-0448
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Fax |
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Provider Business Mailing Address
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Address Line | 190 CURTIS PKWY NE SUITE B
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City | CALHOUN
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State | GA
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Zip | 30701-2057
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Country | US
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Telephone | 706-602-0448
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TONYA W BAKER
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Credential | DMD, PC
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Telephone | 706-602-0448
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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 | 4118
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License Number State | GA
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