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General NPI Number Information
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NPI Number | 1518652171
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Entity Type | Organization
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Legal Business Name | PONCE DENTAL STUDIO LLC
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 892 PONCE DE LEON AVE NE STE 100
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City | ATLANTA
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State | GA
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Zip | 30306-4239
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Country | US
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Telephone | 404-345-2757
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Fax |
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Provider Business Mailing Address
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Address Line | 892 PONCE DE LEON AVE NE STE 100
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City | ATLANTA
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State | GA
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Zip | 30306-4239
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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 | REVENUE CYCLE MANAGER
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Name | ASHLEY THOMAS
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Credential |
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Telephone | 678-333-8463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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