Professional Dental Alliance of Conyers, LLC

NPI #1811554058 in Conyers, Georgia

Provider Information

NPI Number: 1811554058
Entity Type: Organization
Organization Name: Professional Dental Alliance of Conyers, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: May 23, 2019
Last Updated: May 23, 2019

Practice Location

Address: 1820 GEORGIA HIGHWAY 20 SE STE 148
City: Conyers
State: Georgia
ZIP Code: 30013-2076
Phone: (770) 922-4375

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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