| Patriots Park Dental, Llc | |
|
701 Devika Drive, Ste 10 Grovetown GA 30813 | |
| (706) 664-0744 | |
| Not Available |
| Full Name | Patriots Park Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 701 Devika Drive, Ste 10, Grovetown, Georgia |
| Authorized Official Name and Position | Thomas Joseph Moreno (MANAGER) |
| Authorized Official Contact | 7066640744 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Patriots Park Dental, Llc 701 Devika Dr Ste 10 Grovetown GA 30813-5136 Ph: (706) 664-0744 | Patriots Park Dental, Llc 701 Devika Drive, Ste 10 Grovetown GA 30813 Ph: (706) 664-0744 |
| NPI Number | 1689002610 |
|---|---|
| Provider Enumeration Date | 10/30/2013 |
| Last Update Date | 10/30/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689002610 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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