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General NPI Number Information
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NPI Number | 1336771948
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Entity Type | Organization
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Legal Business Name | GADENTALGRP, LLC
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 2018 MONTREAL RD
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City | TUCKER
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State | GA
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Zip | 30084-5203
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Country | US
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Telephone | 770-939-5122
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Fax |
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Provider Business Mailing Address
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Address Line | 919 PINE COVE DR
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City | LILBURN
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State | GA
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Zip | 30047-1401
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Country | US
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Telephone | 770-401-4190
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JIGAR DESAI
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Credential | DDS
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Telephone | 770-401-4190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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