NPI 1851729883

Avala Dental Providers,llc

Organisation Point of Service Lilburn, GA

Practice location

Address: 629 a Beaver Ruin Rd, Lilburn, GA 30047
Phone: (770) 696-4144
Fax: (470) 545-2859

Authorised official

Name: Tiffany N Jamison
Title: Owner
Phone: (770) 696-4144

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X Licence DN014034 (GA)

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Registry record

NPI: 1851729883
Entity type: Organization
NPI issued: 30 Oct 2013
Record last updated: 30 Oct 2013

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.