MEDICARE: DR. ROBERTA D CANN D.M.D.

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	1223G0001X	General Practice Dentistry	9797	GA

General Provider Information

NPI Number	:	1366532210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTA D CANN D.M.D.

Provider Business Mailing Address
First Line	:	3525 PIEDMONT RD.
Second Line	:	SUITE 408
City	:	ATLANTA
State	:	GA
Zip	:	30305
Country	:	US
Telephone Number	:	404-233-1102
Fax Number	:	404-233-2317

Provider Business Practice Location Address
First Line	:	3525 PIEDMONT ROAD
Second Line	:	SUITE 408
City	:	ATLANTA
State	:	GA
Zip	:	30305
Country	:	US
Telephone Number	:	404-233-1102
Fax Number	:	404-233-2317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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