Provider Demographics
NPI:1760844849
Name:CHOICE ONE DENTAL CARE OF ROSWELL
Entity Type:Organization
Organization Name:CHOICE ONE DENTAL CARE OF ROSWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-518-7475
Mailing Address - Street 1:910 WOODSTOCK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-8217
Mailing Address - Country:US
Mailing Address - Phone:770-518-7475
Mailing Address - Fax:770-818-5602
Practice Address - Street 1:910 WOODSTOCK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-8217
Practice Address - Country:US
Practice Address - Phone:770-518-7475
Practice Address - Fax:770-818-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty