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General NPI Number Information
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NPI Number | 1831316280
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Entity Type | Organization
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Legal Business Name | EAST MARIETTA FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3823 ROSWELL RD SUITE 104
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City | MARIETTA
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State | GA
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Zip | 30062-6278
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Country | US
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Telephone | 770-977-1632
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Fax | 770-578-8140
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Provider Business Mailing Address
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Address Line | 3823 ROSWELL RD SUITE 104
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City | MARIETTA
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State | GA
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Zip | 30062-6278
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Country | US
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Telephone | 770-977-1632
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Fax | 770-578-8140
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM ROBERT HANSMANN
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Credential | D.D.S.
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Telephone | 770-977-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7874
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License Number State | GA
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