MEDICARE: PERIMETER DENTAL EAST COBB

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1093423253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERIMETER DENTAL EAST COBB

Provider Business Mailing Address
First Line	:	1070 WOODLAWN DR NE STE 100
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-4290
Country	:	US
Telephone Number	:	770-977-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 WOODLAWN DR NE STE 100
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-4290
Country	:	US
Telephone Number	:	770-977-7600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NELSON YANG
Credential	:	DMD
Telephone Number	:	770-977-7600

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	11/07/2022

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