Lilburn Dental Group, L.l.c.

NPI #1346322989 in Lilburn, Georgia

Provider Information

NPI Number: 1346322989
Entity Type: Organization
Organization Name: Lilburn Dental Group, L.l.c.
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 20, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 912 KILLIAN HILL RD SW
Address 2: SUITE 100
City: Lilburn
State: Georgia
ZIP Code: 30047-3138
Phone: (770) 923-3966

Authorized Official

Name: DR. RICHARD GANGWISCH, D.D.S.
Title: MEMBER
Phone: (770) 923-3966

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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