| Cedar Dental Clinical I, Llc | |
|
18 Riverbend Dr Sw Ste 230 Rome GA 30161-6019 | |
| (706) 591-8192 | |
| (706) 591-8103 |
| Full Name | Cedar Dental Clinical I, Llc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 18 Riverbend Dr Sw Ste 230, Rome, Georgia |
| Authorized Official Name and Position | Henry Rankin Dallam (PRESIDENT) |
| Authorized Official Contact | 7703312529 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedar Dental Clinical I, Llc 6801 Governors Lake Pkwy Ste 290 Peachtree Corners GA 30071-1136 Ph: (678) 978-3099 | Cedar Dental Clinical I, Llc 18 Riverbend Dr Sw Ste 230 Rome GA 30161-6019 Ph: (706) 591-8192 |
| NPI Number | 1366059396 |
|---|---|
| Provider Enumeration Date | 09/24/2020 |
| Last Update Date | 09/24/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366059396 | NPI | - | NPPES |
| DN013071 | Other | GA | GA DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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