MEDICARE: PERIMETER PEDIATRIC DENTISTRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN 13057	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003123563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERIMETER PEDIATRIC DENTISTRY PC

Provider Business Mailing Address
First Line	:	10930 CRABAPPLE RD
Second Line	:	STE106
City	:	ROSWELL
State	:	GA
Zip	:	30075-5813
Country	:	US
Telephone Number	:	678-763-2600
Fax Number	:	678-352-1029

Provider Business Practice Location Address
First Line	:	2221 JOHNSON FERRY RD NE
Second Line	:	STE 2-A
City	:	ATLANTA
State	:	GA
Zip	:	30319-2203
Country	:	US
Telephone Number	:	678-763-2600
Fax Number	:	678-893-0459

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VISHANT NATH
Credential	:	DMD
Telephone Number	:	678-763-2600

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	09/07/2010

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