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General NPI Number Information
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NPI Number | 1740723311
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Entity Type | Organization
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Legal Business Name | MICHELLE GWYN DDS, PC
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 5040 BILL GARDNER PKWY STE 300
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City | LOCUST GROVE
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State | GA
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Zip | 30248-3758
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Country | US
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Telephone | 678-304-8408
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Fax | 689-304-8409
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Provider Business Mailing Address
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Address Line | 5040 BILL GARDNER PKWY STE 300
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City | LOCUST GROVE
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State | GA
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Zip | 30248-3758
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Country | US
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Telephone | 678-304-8408
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Fax | 689-304-8409
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELLE SANDRA GWYN
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Credential | DDS
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Telephone | 678-304-8408
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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 | DN013195
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License Number State | GA
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