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General NPI Number Information
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NPI Number | 1912200528
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Entity Type | Organization
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Legal Business Name | WINDY HILL DENTAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 2070 S PARK PL SE SUITE 330
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City | ATLANTA
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State | GA
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Zip | 30339-2045
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Country | US
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Telephone | 770-955-1188
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Fax |
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Provider Business Mailing Address
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Address Line | 2070 S PARK PL SE SUITE 330
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City | ATLANTA
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State | GA
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Zip | 30339-2045
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Country | US
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Telephone | 770-955-1188
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Fax |
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Authorized Official
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Title or Position | COO
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Name | LORI SPENCE
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Credential |
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Telephone | 770-312-5167
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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 | DN008548
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License Number State | GA
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