NPI 1003423039 · live from the CMS NPI Registry
Cedar Dental Clinical I, LLC
Dentist, Orthodontics and Dentofacial Orthopedics in Mcdonough, GA. National Provider Identifier 1003423039, active.
NPI record
| NPI | 1003423039 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Orthodontics and Dentofacial Orthopedics 1223X0400X |
| Practice location | 119 Willow Ln, Mcdonough, GA 30253 |
| Practice phone | 678-432-8505 |
| Mailing address | 6801 Governors Lake Pkwy Ste 290, Peachtree Corners, GA 30071 |
| Enumerated | September 24, 2020 |
| Last updated | September 24, 2020 |
| Authorized official | Henry Dallam, President |
| Other names | Orthodontic Care Of Georgia |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Orthodontics and Dentofacial Orthopedics primary | 1223X0400X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.