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General NPI Number Information
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NPI Number | 1174491187
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Entity Type | Organization
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Legal Business Name | DENTAL TOWN EMERGENCY SERVICES LLC
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 2020 CUMMING HWY STE 100
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City | CANTON
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State | GA
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Zip | 30115-8071
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Country | US
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Telephone | 770-741-0439
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Fax |
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Provider Business Mailing Address
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Address Line | 2970 BRANDYWINE RD STE 200
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City | ATLANTA
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State | GA
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Zip | 30341-5549
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Country | US
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Telephone | 770-692-1000
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING & ENROLLMENT DIRECTOR
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Name | JO ANN RICE
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Credential |
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Telephone | 470-881-8679
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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