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NPI Code Detail

MEDICARE: JAMESTOWN CONDOTTIERE IMPLANT&GENERAL DENTISTRY CTR. P.C.

MEDICARE: JAMESTOWN CONDOTTIERE IMPLANT&GENERAL DENTISTRY CTR. 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
11223G0001XGeneral Practice DentistryDNO11947GA

Other Identifiers

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

General Provider Information

NPI Number : 1801069240
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAMESTOWN CONDOTTIERE IMPLANT&GENERAL DENTISTRY CTR. P.C.
Provider Business Mailing Address
First Line : 2457 RIVERDALE RD
Second Line :
City : ATLANTA
State : GA
Zip : 30350
Country : US
Telephone Number : 404-767-9356
Fax Number : 404-529-4465
Provider Business Practice Location Address
First Line : 2457 RIVERDALE RD
Second Line :
City : ATLANTA
State : GA
Zip : 30337-5003
Country : US
Telephone Number : 404-767-9356
Fax Number : 404-529-4465
Authorized Official
Title or Position : OWNER
Name : ALDOUS WILSON
Credential :
Telephone Number : 404-767-9356
Provider Enumeration Date : 04/07/2008
Last Update Date : 04/07/2008

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