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General NPI Number Information
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NPI Number | 1396850939
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Entity Type | Organization
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Legal Business Name | CHOATE DENTAL ASSOC PC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 211 E MAIN ST
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City | CARTERSVILLE
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State | GA
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Zip | 30120
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Country | US
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Telephone | 770-382-0921
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Fax | 770-607-1821
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Provider Business Mailing Address
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Address Line | PO BOX 400 211 E MAIN ST
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City | CARTERSVILLE
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State | GA
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Zip | 30120
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Country | US
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Telephone | 770-382-0921
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Fax | 770-607-1821
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Authorized Official
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Title or Position | PRES CHOATE DENTAL ASSOC PC
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Name | DR. ZIM JACKSON CHOATE
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Credential | DDS
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Telephone | 770-382-0921
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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 | 6946
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License Number State | GA
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