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General NPI Number Information
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NPI Number | 1629128988
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Entity Type | Organization
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Legal Business Name | SUGARLOAF CROSSING DENTAL CENTER LLC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4850 SUGARLOAF PKWY SUITE 204
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2859
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Country | US
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Telephone | 770-995-6109
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Fax | 770-995-6128
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Provider Business Mailing Address
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Address Line | 4850 SUGARLOAF PKWY SUITE 204
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2859
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Country | US
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Telephone | 770-995-6109
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | WILLIAM ANDREW LITTON
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Credential |
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Telephone | 678-879-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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