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General NPI Number Information
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NPI Number | 1316107709
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Entity Type | Organization
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Legal Business Name | J MICHAEL DIERKES FAMILY ORTHODONTICS LLC
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 910 MARIETTA HWY SUITE
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City | ROSWELL
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State | GA
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Zip | 30075-6771
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Country | US
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Telephone | 678-352-0919
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Fax | 678-352-8330
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Provider Business Mailing Address
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Address Line | 910 MARIETTA HWY SUITE
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City | ROSWELL
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State | GA
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Zip | 30075-6771
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Country | US
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Telephone | 678-352-0919
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Fax | 678-352-8330
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Authorized Official
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Title or Position | PRES
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Name | DR. JOHN MICHAEL DIERKES
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Credential | DDS MS FICCMO NMD
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Telephone | 678-352-0919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 9675
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License Number State | GA
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