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NPI Code Detail

MEDICARE: ALDEN BRIDGE DENTAL, P.C.

MEDICARE: ALDEN BRIDGE DENTAL, P.C.
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
11223E0200XEndodontics
21223S0112XOral and Maxillofacial Surgery (Dentist)
31223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1750789145
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALDEN BRIDGE DENTAL, P.C.
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 : 770-916-5031
Fax Number : 678-247-7966
Provider Business Practice Location Address
First Line : 8000 RESEARCH FOREST DR STE 350
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77382-1560
Country : US
Telephone Number : 770-916-5031
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CHAITRA SHANTHAGOWDA ARAKERE
Credential : D.M.D.
Telephone Number : 281-363-4345
Provider Enumeration Date : 12/17/2014
Last Update Date : 12/06/2016

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Directions to “ALDEN BRIDGE DENTAL, P.C. ” Practice Location

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