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General NPI Number Information
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NPI Number | 1598811739
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Entity Type | Organization
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Legal Business Name | ATHENS AREA PEDIATRIC DENTISTRY, P.C.
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 1091 PARK DR STE A
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City | WATKINSVILLE
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State | GA
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Zip | 30677-2014
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Country | US
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Telephone | 706-769-1994
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Fax | 706-769-1997
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Provider Business Mailing Address
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Address Line | PO BOX 1619
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City | WATKINSVILLE
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State | GA
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Zip | 30677-0032
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Country | US
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Telephone | 706-769-1994
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Fax | 706-769-1997
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Authorized Official
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Title or Position | OWNER,DMD
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Name | EMILY J. BRADLEY
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Credential | DMD
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Telephone | 706-769-1994
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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 | 010004
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License Number State | GA
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