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General NPI Number Information
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NPI Number | 1871963447
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL CENTER, PC
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 1010 N TENNESSEE ST STE 105
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City | CARTERSVILLE
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State | GA
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Zip | 30120-8525
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Country | US
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Telephone | 770-672-7481
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Fax | 770-382-1915
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Provider Business Mailing Address
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Address Line | 1010 N TENNESSEE ST STE 105
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City | CARTERSVILLE
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State | GA
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Zip | 30120-8525
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Country | US
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Telephone | 770-672-7481
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JENNIFER A CLINE
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Credential |
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Telephone | 770-672-7481
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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