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General NPI Number Information
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NPI Number | 1528331923
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Entity Type | Organization
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Legal Business Name | ATLANTA DENTAL TEAM STONE MOUNTAIN PC
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 1000 MAIN ST SUITE F
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-2978
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Country | US
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Telephone | 770-469-1331
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 MAIN ST SUITE F
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-2978
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Country | US
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Telephone | 770-469-1331
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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. DARREN A OWENS
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Credential | DDS
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Telephone | 770-469-1331
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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 | DN09316
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12130GA
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License Number State | GA
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