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General NPI Number Information
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NPI Number | 1790046464
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Entity Type | Organization
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Legal Business Name | CHILDRENS DENTISTRY AT STONECREST
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 8180 MALL PKWY 810
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City | LITHONIA
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State | GA
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Zip | 30038-6911
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Country | US
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Telephone | 770-484-4994
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Fax | 770-484-4575
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Provider Business Mailing Address
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Address Line | 8180 MALL PKWY 810
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City | LITHONIA
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State | GA
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Zip | 30038-6911
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Country | US
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Telephone | 770-484-4994
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Fax | 770-484-4575
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. SONYA LYNETTE WINDHAM
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Credential | DMD
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Telephone | 770-484-4994
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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 | DN012294
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License Number State | GA
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