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General NPI Number Information
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NPI Number | 1346582566
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Entity Type | Organization
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Legal Business Name | NOVA DENTAL, PC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 1134 SENOIA RD STE A2
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City | TYRONE
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State | GA
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Zip | 30290-1622
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Country | US
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Telephone | 770-253-5885
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Fax |
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Provider Business Mailing Address
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Address Line | 31 JESSICA LN
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City | NEWNAN
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State | GA
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Zip | 30263-7069
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Country | US
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Telephone | 770-253-5885
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JULIANE S REYNOLDS
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Credential | DDS
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Telephone | 770-253-5885
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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 | DN013488
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License Number State | GA
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