| Cosmetic And Family Dentistry Of Roswell | |
|
1611 Sands Pl Se Ste 100 Marietta GA 30067-8704 | |
| (770) 226-0008 | |
| (770) 226-0700 |
| Full Name | Cosmetic And Family Dentistry Of Roswell |
|---|---|
| Speciality | Dentist |
| Location | 1611 Sands Pl Se Ste 100, Marietta, Georgia |
| Authorized Official Name and Position | Kenneth Morris Wiggins (DR./DENTIST) |
| Authorized Official Contact | 7702260008 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cosmetic And Family Dentistry Of Roswell Po Box 7718 Marietta GA 30065-1718 Ph: (770) 226-0008 | Cosmetic And Family Dentistry Of Roswell 1611 Sands Pl Se Ste 100 Marietta GA 30067-8704 Ph: (770) 226-0008 |
| NPI Number | 1023264322 |
|---|---|
| Provider Enumeration Date | 08/18/2008 |
| Last Update Date | 08/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023264322 | NPI | - | NPPES |
| 829858019A | Medicaid | GA | |
| 829858019B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN012484 (Georgia) | Secondary |
| 122300000X | Dentist | DN012485 (Georgia) | Primary |
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