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NPI Code Detail

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

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
11223G0001XGeneral Practice Dentistry9797GA

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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