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General NPI Number Information
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NPI Number | 1760921480
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Entity Type | Organization
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Legal Business Name | PEACHTREE CHILDRENS DENTISTRY GAINESVILLE LLC
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 885 DAWSONVILLE HWY. SUITE 1130
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City | GAINESVILLE
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State | GA
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Zip | 30501
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Country | US
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Telephone | 770-497-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 885 DAWSONVILLE HWY. SUITE 1130
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City | GAINESVILLE
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State | GA
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Zip | 30501
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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 | CO-OWNER
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Name | NAMEUN NANCY KIL
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Credential | DDS
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Telephone | 678-438-1833
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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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