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General NPI Number Information
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NPI Number | 1548973878
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Entity Type | Organization
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Legal Business Name | ATLANTA WEST PERIODNTICS AND DENTAL IMPLANTS, PC
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 2168 SKYVIEW DR
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-2638
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Country | US
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Telephone | 770-739-5097
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Fax |
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Provider Business Mailing Address
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Address Line | 2168 SKYVIEW DR
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-2638
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Country | US
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Telephone | 770-739-5097
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHUONG THAO TRAN NGUYEN
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Credential | DDS, MSD
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Telephone | 832-566-7358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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