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General NPI Number Information
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NPI Number | 1992847610
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Entity Type | Organization
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Legal Business Name | SUSAN ALEXANDER, DMD, PC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3020 ROSWELL RD STE 130
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City | MARIETTA
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State | GA
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Zip | 30062-4987
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Country | US
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Telephone | 770-509-2310
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Fax | 770-993-5987
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Provider Business Mailing Address
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Address Line | 3020 ROSWELL RD STE 130
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City | MARIETTA
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State | GA
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Zip | 30062-4987
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Country | US
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Telephone | 770-509-2310
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Fax | 770-993-5987
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN ALEXANDER
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Credential | D.M.D.
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Telephone | 770-509-2310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 010295
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License Number State | GA
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