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General NPI Number Information
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NPI Number | 1689169096
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Entity Type | Organization
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Legal Business Name | DENTAL CARE CENTER OF DECATUR LLC
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 2530 LAWRENCEVILLE HWY
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City | DECATUR
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State | GA
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Zip | 30033
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Country | US
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Telephone | 770-939-9779
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Fax | 770-939-2393
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Provider Business Mailing Address
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Address Line | 2530 LAWRENCEVILLE HWY
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City | DECATUR
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State | GA
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Zip | 30033
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Country | US
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Telephone | 770-939-9779
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Fax | 770-939-2393
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Authorized Official
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Title or Position | CEO
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Name | DR. LYNN ALLEN LIVINGSTON JR.
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Credential | DDS
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Telephone | 770-939-9779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN012830
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License Number State | GA
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