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General NPI Number Information
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NPI Number | 1952812737
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Entity Type | Organization
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Legal Business Name | PEDOZONE, LLC
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 8879 DALLAS ACWORTH HWY
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City | DALLAS
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State | GA
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Zip | 30132-7905
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Country | US
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Telephone | 770-974-3633
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Fax | 770-974-3660
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Provider Business Mailing Address
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Address Line | 3104 CREEKSIDE VILLAGE DR NW STE 401
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City | KENNESAW
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State | GA
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Zip | 30144-2393
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Country | US
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Telephone | 770-974-3633
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Fax |
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Authorized Official
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Title or Position | TREATMENT COORDINATOR
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Name | MRS. CRYSTAL DEANN SMITH
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Credential |
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Telephone | 770-974-3633
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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 | DNO14556
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License Number State | GA
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