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NPI Code Detail

MEDICARE: EAST COBB FAMILY DENTISTRY

MEDICARE: EAST COBB FAMILY 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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1588915581
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST COBB FAMILY DENTISTRY
Provider Business Mailing Address
First Line : 2969 JOHNSON FERRY RD
Second Line :
City : MARIETTA
State : GA
Zip : 30062-5653
Country : US
Telephone Number : 404-537-5211
Fax Number : 770-809-5013
Provider Business Practice Location Address
First Line : 2969 JOHNSON FERRY RD
Second Line :
City : MARIETTA
State : GA
Zip : 30062-5653
Country : US
Telephone Number : 404-537-5211
Fax Number : 770-809-5013
Authorized Official
Title or Position : OWNER/DENTIST
Name : KENNETH TRALONGO
Credential : DDS
Telephone Number : 770-992-2340
Provider Enumeration Date : 10/01/2012
Last Update Date : 10/01/2012

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Directions to “EAST COBB FAMILY DENTISTRY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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