| Mouthpeace Dental 4, Llc | |
|
541 Forest Pkwy Ste 18 Forest Park GA 30297-6110 | |
| (404) 228-6801 | |
| Not Available |
| Full Name | Mouthpeace Dental 4, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 541 Forest Pkwy Ste 18, Forest Park, Georgia |
| Authorized Official Name and Position | Syretta Wells (OWNER /DENTIST) |
| Authorized Official Contact | 3123711423 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mouthpeace Dental 4, Llc 2149 Brannen Rd Se Atlanta GA 30316-4117 Ph: (312) 371-1423 | Mouthpeace Dental 4, Llc 541 Forest Pkwy Ste 18 Forest Park GA 30297-6110 Ph: (404) 228-6801 |
| NPI Number | 1811516479 |
|---|---|
| Provider Enumeration Date | 04/14/2020 |
| Last Update Date | 04/14/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811516479 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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