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General NPI Number Information
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NPI Number | 1154788313
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Entity Type | Organization
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Legal Business Name | TOUCHSTONE ORTHODONTICS LLC
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 3350 RIVERWOOD PKWY SE SUITE 2130
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City | ATLANTA
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State | GA
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Zip | 30339-6401
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Country | US
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Telephone | 770-850-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 3350 RIVERWOOD PKWY SE SUITE 2130
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City | ATLANTA
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State | GA
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Zip | 30339-6401
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Country | US
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Telephone | 770-850-9119
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MERIDITH LONG DAUTOVIC
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Credential | DMD, MS
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Telephone | 404-983-0237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN012254
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License Number State | GA
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