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General NPI Number Information
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NPI Number | 1437487550
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Entity Type | Organization
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Legal Business Name | LANA L. MAMUT, DMD, PC
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Dates
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Enumeration Date | 12/01/2009
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 3130 MATHIS AIRPORT PKWY STE 309
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City | SUWANEE
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State | GA
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Zip | 30024-9131
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Country | US
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Telephone | 404-579-0519
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 MATHIS AIRPORT PKWY STE 309
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City | SUWANEE
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State | GA
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Zip | 30024-9131
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Country | US
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Telephone | 404-579-0519
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. LANA LVOVNA MAMUT
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Credential | DMD
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Telephone | 404-579-0519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN012943
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License Number State | GA
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