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General NPI Number Information
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NPI Number | 1922533868
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Entity Type | Organization
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Legal Business Name | NEWTOWN FAMILY DENTAL PC
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 3280 OLD ALABAMA RD SUITE 200
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City | JOHNS CREEK
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State | GA
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Zip | 30022-8544
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Country | US
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Telephone | 404-437-7331
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Fax | 404-437-7599
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Provider Business Mailing Address
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Address Line | 3280 OLD ALABAMA RD SUITE 200
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City | JOHNS CREEK
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State | GA
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Zip | 30022-8544
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Country | US
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Telephone | 404-437-7331
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Fax | 404-437-7599
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ALIM J GRANT SR.
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Credential | DDS
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Telephone | 678-571-6984
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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 | DN012743
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License Number State | GA
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