NPI 1073894911

Region Dental

Organisation Preferred Provider Organization Snellville, GA

Practice location

Address: 2488 Scenic Hwy S, Snellville, GA 30078-5710
Phone: (770) 736-2984
Fax: (770) 736-2987

Authorised official

Name: Jewell Toussiant
Title: Owner
Phone: (770) 736-2984

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence DN014167 (TN)

Other Preferred Provider Organization providers in Georgia →

Registry record

NPI: 1073894911
Entity type: Organization
NPI issued: 6 Sep 2011
Record last updated: 6 Sep 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.