Peach Blossom Dental, LLC
Clinic/Center, Dental in Tucker, GA. Organization (NPI-2).
NPI number1174051908
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1174051908
- Entity type
- Organization (NPI-2)
- Legal business name
- Peach Blossom Dental, LLC
- Organization subpart
- No
- Enumeration date
- May 24, 2017
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
2256 Northlake Pkwy Ste 150Tucker, GA 30084-4004
Phone 770-934-5144 · Fax 678-273-3634
Mailing address
2256 Northlake Pkwy Ste 150Tucker, GA 30084-4004
Phone 770-934-5144 · Fax 678-273-3634
Authorized official
Angela Dawn Wright
Owner
7709345144
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