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General NPI Number Information
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NPI Number | 1497222053
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Entity Type | Organization
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Legal Business Name | KIDZ TOOTH ZONE, LLC
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 907 PAVILION CT
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City | MCDONOUGH
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State | GA
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Zip | 30253-6665
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Country | US
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Telephone | 678-272-6195
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Fax | 678-759-1926
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Provider Business Mailing Address
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Address Line | 907 PAVILION CT
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City | MCDONOUGH
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State | GA
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Zip | 30253-6665
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Country | US
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Telephone | 678-272-6195
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Fax | 678-759-1926
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CAROLYN WILMER WILLIAMS
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Credential | D.D.S.
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Telephone | 404-960-8208
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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 |
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License Number State |
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