Provider Demographics
NPI:1164565172
Name:WORRALL, FRED FRANCIS II (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:FRANCIS
Last Name:WORRALL
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:707 WHITLOCK AVE SW
Mailing Address - Street 2:SUITE D29
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3000
Mailing Address - Country:US
Mailing Address - Phone:770-792-2300
Mailing Address - Fax:770-792-2436
Practice Address - Street 1:707 WHITLOCK AVE SW
Practice Address - Street 2:SUITE D29
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3083
Practice Address - Country:US
Practice Address - Phone:770-792-2300
Practice Address - Fax:770-792-2436
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0114021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice