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General NPI Number Information
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NPI Number | 1467649319
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Entity Type | Organization
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Legal Business Name | PEACHTREE CITY DENTISTRY
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 50 EASTBROOK BND
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1530
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Country | US
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Telephone | 770-631-7001
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Fax | 770-631-7005
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Provider Business Mailing Address
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Address Line | 50 EASTBROOK BND
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1530
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Country | US
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Telephone | 770-631-7001
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Fax | 770-631-7005
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Authorized Official
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Title or Position | OWNER
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Name | JOHN D. BLANCHARD
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Credential |
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Telephone | 770-631-7001
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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 |
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License Number State |
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Taxonomy #2
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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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