Provider Demographics
NPI:1346558038
Name:WORTMAN, DANA LEEANN (DA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LEEANN
Last Name:WORTMAN
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2749 ELKHART CIR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4319
Mailing Address - Country:US
Mailing Address - Phone:770-882-6594
Mailing Address - Fax:
Practice Address - Street 1:4150 MACLAND RD STE 205
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-8212
Practice Address - Country:US
Practice Address - Phone:770-222-1344
Practice Address - Fax:770-222-1345
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant