Professional Dental Alliance of Lilburn, LLC

NPI #1710544960 in Lilburn, Georgia

Provider Information

NPI Number: 1710544960
Entity Type: Organization
Organization Name: Professional Dental Alliance of Lilburn, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: May 23, 2019
Last Updated: May 23, 2019

Practice Location

Address: 3970 FIVE FORKS TRICKUM RD SW STE B
City: Lilburn
State: Georgia
ZIP Code: 30047-2339
Phone: (770) 921-8442

Authorized Official

Name: JESSICA BARRETTE
Title: CREDENTIALING SPECIALIST
Phone: (724) 698-2997

Specialties & Taxonomy Codes

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

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