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General NPI Number Information
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NPI Number | 1407363963
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Entity Type | Organization
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Legal Business Name | PD ORTHO LLC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 10930 CRABAPPLE RD STE 106
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City | ROSWELL
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State | GA
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Zip | 30075-5825
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Country | US
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Telephone | 770-651-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 570 W CROSSVILLE RD STE 203
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City | ROSWELL
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State | GA
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Zip | 30075-7517
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Country | US
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Telephone | 770-651-1000
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | KATINA SATTERFIELD
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Credential |
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Telephone | 770-651-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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