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General NPI Number Information
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NPI Number | 1265668412
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTISTRY OF ROSWELL
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 12020 ETRIS RD SUITE A100
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City | ROSWELL
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State | GA
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Zip | 30075-1402
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Country | US
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Telephone | 678-445-5444
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Fax | 770-874-0826
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Provider Business Mailing Address
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Address Line | PO BOX 161
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City | WOODSTOCK
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State | GA
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Zip | 30188-0161
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Country | US
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Telephone | 678-445-5444
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Fax | 770-874-0826
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Authorized Official
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Title or Position | OWNER
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Name | DR. TODD ASARCH
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Credential | DDS
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Telephone | 678-445-5444
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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 | DN013251
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License Number State | GA
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