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General NPI Number Information
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NPI Number | 1780456301
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Entity Type | Organization
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Legal Business Name | TOWN DENTISTRY BROOKHAVEN, LLC
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 804 TOWN BLVD NE STE 2010
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3147
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Country | US
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Telephone | 404-631-6277
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Fax |
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Provider Business Mailing Address
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Address Line | 804 TOWN BLVD NE STE 2010
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3147
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Country | US
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Telephone | 404-631-6277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER RAE FRODGE
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Credential | DMD
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Telephone | 404-476-0814
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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 |
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License Number State |
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