| Cosmetic Family Dentistry Of Roswell | |
|
1087 Alpharetta St Roswell GA 30075-4483 | |
| (770) 650-0992 | |
| Not Available |
| Full Name | Cosmetic Family Dentistry Of Roswell |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1087 Alpharetta St, Roswell, Georgia |
| Authorized Official Name and Position | Kenneth Morris Wiggins (PRESIDENT) |
| Authorized Official Contact | 7702260008 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cosmetic Family Dentistry Of Roswell 1087 Alpharetta St Roswell GA 30075-4483 Ph: (770) 650-0992 | Cosmetic Family Dentistry Of Roswell 1087 Alpharetta St Roswell GA 30075-4483 Ph: (770) 650-0992 |
| NPI Number | 1538392493 |
|---|---|
| Provider Enumeration Date | 08/26/2009 |
| Last Update Date | 08/26/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538392493 | NPI | - | NPPES |
| 329140584A | Medicaid | GA | |
| 829858019A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN012484 (Georgia) | Primary |
| 261QD0000X | Clinic/center - Dental | DN012485 (Georgia) | Secondary |
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