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General NPI Number Information
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NPI Number | 1194972901
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA DENTAL SEDATION CENTER
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 655 JESSE JEWEL PKWY SE SUITE E
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City | GAINESVILLE
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State | GA
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Zip | 30501
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Country | US
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Telephone | 770-539-9110
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Fax | 678-714-8388
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Provider Business Mailing Address
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Address Line | 655 JESSE JEWELL PKWY SE SUITE
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City | GAINESVILLE
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State | GA
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Zip | 30501-3756
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Country | US
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Telephone | 770-539-9110
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Fax | 678-714-8388
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIELLA RAMOS
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Credential |
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Telephone | 678-714-7011
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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 | DN013443
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN008032
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN012082
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License Number State | GA
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