MEDICARE: DR, DAVID M. VIETH 2 PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
2	1223E0200X	Endodontics
3	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1619138666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR, DAVID M. VIETH 2 PC

Provider Business Mailing Address
First Line	:	1090 NORTHCHASE PKWY SE STE 150
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-6407
Country	:	US
Telephone Number	:	770-916-5028
Fax Number	:	678-247-7858

Provider Business Practice Location Address
First Line	:	1900 N BROADWAY
Second Line	:	SUITE 102
City	:	BALTIMORE
State	:	MD
Zip	:	21213-1444
Country	:	US
Telephone Number	:	443-957-1602
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID VIETH
Credential	:	DDS
Telephone Number	:	770-916-5028

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	12/17/2014

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