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General NPI Number Information
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NPI Number | 1942535091
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Entity Type | Organization
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Legal Business Name | CASSANDRA G. BRACKETT, D.D.S.,P.C.
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 3300 MEMORIAL DR SUITE D-3
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City | DECATUR
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State | GA
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Zip | 30032-2700
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Country | US
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Telephone | 404-289-3060
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Fax | 404-288-6080
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Provider Business Mailing Address
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Address Line | 3300 MEMORIAL DR SUITE D-3
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City | DECATUR
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State | GA
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Zip | 30032-2700
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Country | US
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Telephone | 404-289-3060
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Fax | 404-288-6080
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Authorized Official
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Title or Position | CEO
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Name | DR. CASSANDRA G. BRACKETT
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Credential | D.D.S.
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Telephone | 404-289-3060
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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 | 0010117
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License Number State | GA
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