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General NPI Number Information
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NPI Number | 1821394511
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Entity Type | Organization
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Legal Business Name | KENNESTONE PERIODONTICS AT WINDY HILL, PC
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 2070 S PARK PL SE SUITE 200
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City | ATLANTA
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State | GA
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Zip | 30339-2045
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Country | US
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Telephone | 770-952-5432
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Fax | 770-952-3011
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Provider Business Mailing Address
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Address Line | 2070 S PARK PL SE SUITE 200
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City | ATLANTA
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State | GA
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Zip | 30339-2045
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Country | US
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Telephone | 770-952-5432
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Fax | 770-952-3011
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEE HOWARD SILVERSTEIN
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Credential | DDS, MS
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Telephone | 770-952-5432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 10742
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 11384
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License Number State | GA
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