=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669237590
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CROXTON DENTAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2024
-----------------------------------------------------
Last Update Date | 02/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8709 DALLAS ACWORTH HWY
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30132-2177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-693-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 WHITLOCK AVE SW STE A
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30064-1971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-680-9028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/PARTNER
-----------------------------------------------------
Name | DAVID W. CROXTON
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 404-680-9028
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------