MEDICARE: COBB ROOT CANALS

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1689343279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COBB ROOT CANALS

Provider Business Mailing Address
First Line	:	3535 ROSWELL RD STE 56
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-8828
Country	:	US
Telephone Number	:	678-996-6949
Fax Number	:	470-689-3976

Provider Business Practice Location Address
First Line	:	3535 ROSWELL RD STE 56
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-8828
Country	:	US
Telephone Number	:	678-996-6949
Fax Number	:	470-689-3976

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. SHERWAN SARAF
Credential	:
Telephone Number	:	678-996-6949

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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Directions to “COBB ROOT CANALS ” Practice Location

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