NPI 1164687612

Elyse M. Morceau, DDS, PC

Organisation Pediatric Dentistry Kennesaw, GA

Practice location

Address: 205 Hawkins Store Rd NW Suite 100, Kennesaw, GA 30144-6215
Phone: (770) 926-3400
Fax: (770) 926-6317

Authorised official

Name: Michael Morceau
Title: Cfo, Vp
Phone: (770) 926-3400

Registered specialties (4)

Pediatric Dentistry Primary

Dental Providers Taxonomy 1223P0221X Licence DN012309 (GA)

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Pediatric Dentistry

Dental Providers Taxonomy 1223P0221X

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Dental Providers Taxonomy 1223P0221X Licence DN008821 (GA)

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Dental Providers Taxonomy 1223P0221X Licence DN009268 (GA)

Registry record

NPI: 1164687612
Entity type: Organization
NPI issued: 24 Jul 2008
Record last updated: 1 Jul 2012

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.