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General NPI Number Information
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NPI Number | 1336896430
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Entity Type | Organization
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Legal Business Name | WESTSIDE DENTAL, LLC
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 929 LEE ST SW SUITE A240
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City | ATLANTA
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State | GA
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Zip | 30310
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Country | US
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Telephone | 859-620-7587
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Fax |
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Provider Business Mailing Address
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Address Line | 698 LEXINGTON AVE SW
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City | ATLANTA
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State | GA
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Zip | 30310-3536
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Country | US
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Telephone | 859-620-7587
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATHANAEL COLE
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Credential | DMD
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Telephone | 470-548-2962
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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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