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General NPI Number Information
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NPI Number | 1770981763
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Entity Type | Organization
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Legal Business Name | PEACHTREE DUNWOODY ORAL AND FACIAL SURGERY
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 5505 PEACHTREE DUNWOODY RD SUITE 660
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City | ATLANTA
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State | GA
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Zip | 30342-1705
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Country | US
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Telephone | 404-220-7505
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Fax | 404-220-7506
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Provider Business Mailing Address
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Address Line | 5505 PEACHTREE DUNWOODY RD SUITE 660
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City | ATLANTA
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State | GA
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Zip | 30342-1705
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Country | US
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Telephone | 404-220-7505
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Fax | 404-220-7506
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Authorized Official
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Title or Position | INSURANCE ADMINISTRATOR
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Name | MRS. IRENE IVERSON
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Credential |
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Telephone | 404-220-7505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN010345
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License Number State | GA
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