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General NPI Number Information
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NPI Number | 1487863429
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Entity Type | Organization
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Legal Business Name | CENTER FOR COSMETIC AND SEDATION DENTISTRY
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 1030 DULUTH HIGHWAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043
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Country | US
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Telephone | 770-995-1957
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Fax | 770-995-8579
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Provider Business Mailing Address
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Address Line | 1030 DULUTH HIGHWAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043
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Country | US
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Telephone | 770-995-1957
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Fax | 770-995-8579
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RACHEL SMALLWOOD
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Credential |
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Telephone | 770-995-1957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN010916
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License Number State | GA
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