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General NPI Number Information
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NPI Number | 1861886111
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL, PC
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 12 ROUNTREE RD
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City | RIVERDALE
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State | GA
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Zip | 30274-4036
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Country | US
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Telephone | 678-913-4912
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Fax |
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Provider Business Mailing Address
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Address Line | 31 HIGHWAY 138 W SUITE 160
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-4320
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Country | US
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Telephone | 678-913-4912
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONICA MCINTYRE
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Credential | DDS
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Telephone | 678-565-1985
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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 | DN012467
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License Number State | GA
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