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General NPI Number Information
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NPI Number | 1437412889
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Entity Type | Organization
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Legal Business Name | HAMILTON MILL ORAL AND FACIAL SURGERY, LLC
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 06/27/2020
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Provider Practice Location Address
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Address Line | 4285 JIM MOORE RD BLDG 100, SUITE 104
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City | DACULA
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State | GA
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Zip | 30019-1609
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Country | US
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Telephone | 678-835-1135
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Fax | 678-835-1136
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Provider Business Mailing Address
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Address Line | 4285 JIM MOORE RD BLDG 100, SUITE 104
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City | DACULA
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State | GA
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Zip | 30019-1609
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Country | US
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Telephone | 678-835-1135
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Fax | 678-835-1136
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Authorized Official
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Title or Position | OWNER AND DOCTOR
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Name | YADIRA CARDONA-ROHENA
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Credential | DMD
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Telephone | 678-835-1135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN013477
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License Number State | GA
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