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General NPI Number Information
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NPI Number | 1548088081
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Entity Type | Organization
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Legal Business Name | GRIN & COMPANY PEDIATRIC DENTISTRY LLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 954 SEVEN HILLS CONNECTOR RD SUITE 108
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City | ACWORTH
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State | GA
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Zip | 30101
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Country | US
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Telephone | 770-615-8040
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Fax | 770-615-6515
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Provider Business Mailing Address
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Address Line | 6108 SIMONE ST
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City | ACWORTH
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State | GA
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Zip | 30101-1255
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Country | US
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Telephone | 678-414-8472
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SARAH MARTIN BOYLES
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Credential | DMD
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Telephone | 678-414-8472
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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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