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General NPI Number Information
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NPI Number | 1275684797
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Entity Type | Organization
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Legal Business Name | FOUNTAIN OAKS DENTAL P.C.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 3763 ROSWELL RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-4414
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Country | US
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Telephone | 404-261-2211
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Fax | 404-261-1390
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Provider Business Mailing Address
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Address Line | 4920 ROSWELL RD NE STE 13A
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City | ATLANTA
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State | GA
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Zip | 30342-2636
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Country | US
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Telephone | 404-261-2211
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | WILLIAM ANDREW LITTON
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Credential |
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Telephone | 678-879-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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