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General NPI Number Information
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NPI Number | 1952844953
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Entity Type | Organization
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Legal Business Name | MCDONOUGH PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 420 MCDONOUGH PKWY
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City | MCDONOUGH
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State | GA
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Zip | 30253-8946
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Country | US
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Telephone | 770-651-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 420 MCDONOUGH PARKWAY
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City | MCDONOUGH
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State | GA
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Zip | 30253
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Country | US
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Telephone | 770-651-1000
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. VISHANT NATH
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Credential | DMD
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Telephone | 770-651-1000
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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 | DN013057
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License Number State | GA
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