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General NPI Number Information
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NPI Number | 1942871439
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Entity Type | Organization
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Legal Business Name | MOORES MILL MODERN DENTISTRY, PC
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 2250 MARIETTA BLVD, SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30318
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Country | US
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Telephone | 678-369-0104
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Fax | 678-203-2307
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-0050
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Country | US
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Telephone | 714-845-8500
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Fax | 303-952-0892
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Authorized Official
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Title or Position | OWNER
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Name | HOPE K MARSHALL
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Credential | DMD
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Telephone | 678-369-0104
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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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