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NPI Code Detail

MEDICARE: SUGARLOAF CHILDRENS DENTISTRY

MEDICARE: SUGARLOAF CHILDRENS DENTISTRY
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1043042591
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUGARLOAF CHILDRENS DENTISTRY
Provider Business Mailing Address
First Line : 1299 OLD PEACHTREE RD NW STE 102103
Second Line :
City : SUWANEE
State : GA
Zip : 30024-2028
Country : US
Telephone Number : 770-813-9393
Fax Number :
Provider Business Practice Location Address
First Line : 1299 OLD PEACHTREE RD NW STE 102103
Second Line :
City : SUWANEE
State : GA
Zip : 30024-2028
Country : US
Telephone Number : 770-813-9393
Fax Number :
Authorized Official
Title or Position : OWNER
Name : LISA LEE
Credential : DMD
Telephone Number : 770-813-9393
Provider Enumeration Date : 08/14/2024
Last Update Date : 08/14/2024

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Directions to “SUGARLOAF CHILDRENS DENTISTRY ” Practice Location

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