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General NPI Number Information
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NPI Number | 1447698717
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Entity Type | Organization
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Legal Business Name | PEACHTREE CHILDREN'S DENTISTRY BETHLEHEM
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 916 LOGANVILLE HWY
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City | BETHLEHEM
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State | GA
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Zip | 30620-2144
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Country | US
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Telephone | 770-867-5437
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Fax | 770-307-4115
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Provider Business Mailing Address
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Address Line | 916 LOGANVILLE HWY
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City | BETHLEHEM
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State | GA
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Zip | 30620-2144
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Country | US
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Telephone | 770-867-5437
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Fax | 770-307-4115
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TAMARA M COX
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Credential |
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Telephone | 770-979-6400
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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 | DN012595
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN012519
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License Number State | GA
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