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General NPI Number Information
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NPI Number | 1699480723
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Entity Type | Organization
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Legal Business Name | NEWNAN PERIODONTICS AND DENTAL IMPLANTS LLC
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 1635 GA-34 SUITE A
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City | NEWNAN
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State | GA
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Zip | 30265
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Country | US
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Telephone | 770-252-0029
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 GA-34 SUITE A
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City | NEWNAN
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State | GA
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Zip | 30265
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MINDY GIL
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Credential | DMD, DMSC
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Telephone | 617-819-4477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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