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General NPI Number Information
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NPI Number | 1881293538
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Entity Type | Organization
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Legal Business Name | TONGUE-TIE LASER CENTER OF ATLANTA
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 6600 PEACHTREE DUNWOODY RD
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-6773
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Country | US
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Telephone | 470-437-4337
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 PEACHTREE DUNWOODY RD BUILDING 400 SUITE 150
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-6773
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Country | US
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Telephone | 347-598-2410
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. MARK D PERSAUD
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Credential | DDS
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Telephone | 347-598-2410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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