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General NPI Number Information
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NPI Number | 1306019906
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Entity Type | Organization
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Legal Business Name | MIDTOWN DENTAL SERVICES, INC.
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 1014 RALPH DAVID ABERNATHY BLVD SW
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City | ATLANTA
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State | GA
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Zip | 30310-1812
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Country | US
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Telephone | 404-753-3339
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Fax | 404-753-1858
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Provider Business Mailing Address
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Address Line | 1014 RALPH DAVID ABERNATHY BLVD SW
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City | ATLANTA
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State | GA
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Zip | 30310-1812
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Country | US
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Telephone | 404-753-3339
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Fax | 404-753-1858
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | DR. LELA II LEWIS
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Credential | DDS
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Telephone | 404-753-3339
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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 |
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License Number State |
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