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General NPI Number Information
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NPI Number | 1598370454
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Entity Type | Organization
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Legal Business Name | REJUVENESCENCE ORAL & FACIAL SURGERY, DENTAL IMPLANTS, AND COSMETICS, PC
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 3630 SAVANNAH PL STE 250
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City | DULUTH
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State | GA
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Zip | 30096-6394
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 111
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City | DULUTH
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State | GA
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Zip | 30096-0002
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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 | ORAL SURGEON
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Name | DR. KARIN DAVIS
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Credential | DMD
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Telephone | 470-394-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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