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General NPI Number Information
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NPI Number | 1750434643
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Entity Type | Organization
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Legal Business Name | PEACHTREE CHILDREN'S DENTISTRY SNELLVILLE
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 1905 SCENIC HWY N STE 510
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City | SNELLVILLE
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State | GA
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Zip | 30078-5635
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Country | US
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Telephone | 770-979-6400
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Fax | 770-979-7465
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Provider Business Mailing Address
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Address Line | 1905 SCENIC HWY N STE 510
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City | SNELLVILLE
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State | GA
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Zip | 30078-5635
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Country | US
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Telephone | 770-979-6400
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Fax | 770-979-7465
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TAMARA M COX
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Credential | CDA
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Telephone | 770-979-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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