Provider Demographics
NPI:1700030996
Name:CHILDREN'S DENTISTRY OF ROME, LLC
Entity Type:Organization
Organization Name:CHILDREN'S DENTISTRY OF ROME, LLC
Other - Org Name:CHILDREN'S DENTISTRY OF ROME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCSTOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-291-2550
Mailing Address - Street 1:204 REDMOND RD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1538
Mailing Address - Country:US
Mailing Address - Phone:706-291-2550
Mailing Address - Fax:706-291-8349
Practice Address - Street 1:204 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1538
Practice Address - Country:US
Practice Address - Phone:706-291-2550
Practice Address - Fax:706-291-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty