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General NPI Number Information
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NPI Number | 1427428085
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL CENTER, PC
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 15 RIVERBEND DR SW STE 130
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City | ROME
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State | GA
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Zip | 30161-6005
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Country | US
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Telephone | 706-232-1283
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Fax | 770-672-7480
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Provider Business Mailing Address
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Address Line | 15 RIVERBEND DR SW STE 130
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City | ROME
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State | GA
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Zip | 30161-6005
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Country | US
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Telephone | 706-232-1283
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JENNIFER A CLINE
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Credential |
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Telephone | 706-232-1283
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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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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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