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General NPI Number Information
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NPI Number | 1518629161
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Entity Type | Organization
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Legal Business Name | INTOWN ORAL SURGERY, LLC
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 1800 PEACHTREE ST NW STE 850
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City | ATLANTA
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State | GA
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Zip | 30309-2515
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Country | US
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Telephone | 404-643-7543
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 BERNE ST SE
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City | ATLANTA
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State | GA
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Zip | 30316-1807
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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 | OWNER
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Name | DR. JENNIFER D OKHIRIA
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Credential | DDS
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Telephone | 404-643-7543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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