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General NPI Number Information
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NPI Number | 1194281774
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Entity Type | Organization
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Legal Business Name | METROPOLITAN DENTAL & MEDICAL CLINIC INC
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 1720 OLD SPRING HOUSE LN STE 315
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City | DUNWOODY
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State | GA
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Zip | 30338-6215
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Country | US
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Telephone | 770-837-9293
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Fax | 770-837-9243
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Provider Business Mailing Address
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Address Line | 1720 OLD SPRING HOUSE LN STE 315
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City | DUNWOODY
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State | GA
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Zip | 30338-6215
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Country | US
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Telephone | 770-837-9293
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Fax | 770-837-9243
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. LUIS F CAMPOS
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Credential | CDT
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Telephone | 770-837-9293
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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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