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General NPI Number Information
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NPI Number | 1871351403
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Entity Type | Organization
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Legal Business Name | TIMBER RIDGE DENTAL CENTER
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 137 PROMINENCE CT STE 140
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City | DAWSONVILLE
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State | GA
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Zip | 30534-8938
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Country | US
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Telephone | 706-265-6877
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Fax | 866-923-3790
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Provider Business Mailing Address
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Address Line | 5750 STEVEHAVEN LN
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City | CUMMING
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State | GA
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Zip | 30028-5998
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Country | US
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Telephone | 706-502-0722
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Fax | 866-923-3790
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | TONY MICHAEL STANLEY JR.
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Credential | DMD
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Telephone | 706-502-0722
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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 |
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License Number State |
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