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General NPI Number Information
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NPI Number | 1699819938
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Entity Type | Organization
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Legal Business Name | HENDERSON MILL DENTAL CARE, PC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2847 HENDERSON MILL RD
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City | ATLANTA
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State | GA
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Zip | 30341-5772
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Country | US
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Telephone | 770-496-0496
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Fax | 770-496-1758
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Provider Business Mailing Address
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Address Line | 2847 HENDERSON MILL RD
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City | ATLANTA
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State | GA
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Zip | 30341-5772
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Country | US
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Telephone | 770-496-0496
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Fax | 770-496-1758
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | CHARLOTTE WHEELER
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Credential |
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Telephone | 770-496-0496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7904
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License Number State | GA
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