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General NPI Number Information
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NPI Number | 1437573748
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Entity Type | Organization
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Legal Business Name | DENTISTRY AT HICKORY FLAT PC
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 6199 HICKORY FLAT HWY STE 130
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City | CANTON
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State | GA
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Zip | 30115-7255
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Country | US
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Telephone | 770-213-8166
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Fax | 770-213-8157
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Provider Business Mailing Address
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Address Line | 6199 HICKORY FLAT HWY STE 130
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City | CANTON
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State | GA
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Zip | 30115-7255
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Country | US
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Telephone | 770-213-8166
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Fax | 770-213-8157
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | BRIAN Y LEE
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Credential | D.D.S.
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Telephone | 770-213-8166
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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 | DN013420
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN013473
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License Number State | GA
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Taxonomy #3
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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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