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General NPI Number Information
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NPI Number | 1205167962
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Entity Type | Individual
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Provider Name | DANA E NELSON WITHERSPOON DDS
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Gender | Female
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 2000 RIVERSIDE PARKWAY, SUITE 200 GREAT EXPRESSIONS DENTAL CENTERS OF GEORGIA, PC
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043
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Country | US
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Telephone | 202-487-5044
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 RIVERSIDE PARKWAY, SUITE 200 GREAT EXPRESSIONS DENTAL CENTERS OF GEORGIA, PC
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN013754
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8670
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 8670
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License Number State | NC
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