| Blossom Pediatric Dentistry, Llc | |
|
345 Peachtree Industrial Blvd Ste 1102-1103 Suwanee GA 30024-8819 | |
| (770) 609-5603 | |
| Not Available |
| Full Name | Blossom Pediatric Dentistry, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 345 Peachtree Industrial Blvd Ste 1102-1103, Suwanee, Georgia |
| Authorized Official Name and Position | Whitney Lyons (OWNER/DENTIST) |
| Authorized Official Contact | 7706095603 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blossom Pediatric Dentistry, Llc 345 Peachtree Industrial Blvd Ste 1102 Suwanee GA 30024-8823 Ph: (770) 609-4722 | Blossom Pediatric Dentistry, Llc 345 Peachtree Industrial Blvd Ste 1102-1103 Suwanee GA 30024-8819 Ph: (770) 609-5603 |
| NPI Number | 1164145827 |
|---|---|
| Provider Enumeration Date | 09/19/2022 |
| Last Update Date | 08/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164145827 | NPI | - | NPPES |
| 1811302474 | Other | GA | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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