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1217 Royal Dr Sw Conyers GA 30094-5967 | |
| (770) 922-6655 | |
| (770) 388-0521 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1217 Royal Dr Sw, Conyers, Georgia |
| Authorized Official Name and Position | Joe N Lester (OWNER) |
| Authorized Official Contact | 7709226655 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1217 Royal Dr Sw Conyers GA 30094-5967 Ph: (770) 922-6655 | 1217 Royal Dr Sw Conyers GA 30094-5967 Ph: (770) 922-6655 |
| NPI Number | 1659440311 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 06/14/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659440311 | NPI | - | NPPES |
| 801628040C | Medicaid | GA | |
| 039132651A | Medicaid | GA | |
| 000287955H | Medicaid | GA | |
| 000900974A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN009947 (Georgia) | Primary |
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