MEDICARE: METRO DECATUR DENTAL GROUP

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	122300000X	Dentist	DN013291	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710136866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO DECATUR DENTAL GROUP

Provider Business Mailing Address
First Line	:	4570 MEMORIAL DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-1447
Country	:	US
Telephone Number	:	404-292-3133
Fax Number	:	404-935-0905

Provider Business Practice Location Address
First Line	:	4570 MEMORIAL DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-1447
Country	:	US
Telephone Number	:	404-292-3133
Fax Number	:	404-935-0905

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. GARY SIMMS
Credential	:	D.M.D.
Telephone Number	:	404-292-3133

Provider Enumeration Date	:	09/13/2008
Last Update Date	:	09/13/2008

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