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General NPI Number Information
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NPI Number | 1437066982
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTISTRY OF WEST GEORGIA, LLC
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 202 CALUMET CENTER RD
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City | LAGRANGE
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State | GA
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Zip | 30241-6712
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Country | US
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Telephone | 706-298-5007
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Fax |
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Provider Business Mailing Address
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Address Line | 202 CALUMET CENTER RD
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City | LAGRANGE
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State | GA
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Zip | 30241-6712
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Country | US
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Telephone | 706-298-5007
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Fax | 706-298-5008
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA DENISE BULLOCH-PATTERSON
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Credential | DMD
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Telephone | 706-298-5007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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