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General NPI Number Information
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NPI Number | 1558796896
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Entity Type | Organization
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Legal Business Name | MUCCIOLI DENTAL, PC
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 6300 HOSPITAL PKWY SUITE 275
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City | JOHNS CREEK
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State | GA
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Zip | 30097-1828
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Country | US
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Telephone | 678-389-9955
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Fax | 678-389-9952
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Provider Business Mailing Address
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Address Line | 6300 HOSPITAL PKWY SUITE 275
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City | JOHNS CREEK
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State | GA
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Zip | 30097-1828
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Country | US
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Telephone | 678-389-9955
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Fax | 678-389-9952
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. RANDY EARL MUCCIOLI
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Credential | D.M.D
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Telephone | 678-389-9955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN014379
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN014378
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License Number State | GA
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