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General NPI Number Information
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NPI Number | 1962876532
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Entity Type | Organization
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Legal Business Name | DENTAL CENTER OF CARROLLTON
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 409 DIXIE ST
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City | CARROLLTON
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State | GA
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Zip | 30117-3921
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Country | US
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Telephone | 770-834-9682
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Fax | 770-836-0622
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Provider Business Mailing Address
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Address Line | 409 DIXIE ST
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City | CARROLLTON
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State | GA
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Zip | 30117-3921
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Country | US
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Telephone | 770-834-9682
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Fax | 770-836-0622
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. BETSY S AYERS
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Credential | D.M.D.
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Telephone | 770-834-9682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | DN010873
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License Number State | GA
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