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General NPI Number Information
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NPI Number | 1326933029
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Entity Type | Organization
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Legal Business Name | PONCE DENTAL STUDIO BUCKHEAD, LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 3189 MAPLE DR NE
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City | ATLANTA
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State | GA
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Zip | 30305-2501
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Country | US
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Telephone | 404-383-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 3189 MAPLE DR NE
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City | ATLANTA
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State | GA
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Zip | 30305-2501
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Country | US
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Telephone | 404-383-1111
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE SUPPORT
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Name | AMANDA CRAWFORD
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Credential |
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Telephone | 321-750-9537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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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 |
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License Number State |
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