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General NPI Number Information
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NPI Number | 1437694791
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Entity Type | Organization
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Legal Business Name | AESTHETIC RESTORATIVE DENTISTRY, P. C.
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 5000 SHAKERAG HL
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3367
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Country | US
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Telephone | 770-631-0044
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Fax | 770-631-9434
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Provider Business Mailing Address
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Address Line | 5000 SHAKERAG HL
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3367
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Country | US
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Telephone | 770-631-0044
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Fax | 770-631-9434
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Authorized Official
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Title or Position | OWNER
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Name | DR. W TAYLOR DOMINY JR.
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Credential | D.M.D
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Telephone | 770-631-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN010888
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License Number State | GA
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