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General NPI Number Information
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NPI Number | 1497263909
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Entity Type | Organization
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Legal Business Name | PEACH DENTAL ASSOCIATES LLC
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 78 DAWSON VILLAGE WAY N STE 170
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City | DAWSONVILLE
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State | GA
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Zip | 30534-5643
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Country | US
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Telephone | 407-340-4304
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Fax |
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Provider Business Mailing Address
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Address Line | 819 THOMPSON BRIDGE RD
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City | GAINESVILLE
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State | GA
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Zip | 30501-1774
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FRONT OFFICE
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Name | DESIREE THOMPSON
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Credential |
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Telephone | 770-535-8900
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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 | DN013552
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License Number State | GA
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