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General NPI Number Information
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NPI Number | 1649080037
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Entity Type | Organization
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Legal Business Name | DEPEW AND YOUNG ORTHODONTICS, LLC
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 2161 CEDARCREST RD
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City | ACWORTH
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State | GA
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Zip | 30101-6404
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Country | US
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Telephone | 770-974-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 2161 CEDARCREST RD
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City | ACWORTH
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State | GA
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Zip | 30101-6404
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Country | US
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Telephone | 770-974-8255
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | DR. DONALD DOUGLAS DEPEW
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Credential | DMD, MS
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Telephone | 770-422-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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