Provider Demographics
NPI:1952502528
Name:EDGE, LIZZETTE GARCIA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:LIZZETTE
Middle Name:GARCIA
Last Name:EDGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 ACWORTH DUE WEST RD NW STE A
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2371
Mailing Address - Country:US
Mailing Address - Phone:770-974-5293
Mailing Address - Fax:770-974-7285
Practice Address - Street 1:3420 ACWORTH DUE WEST RD NW STE A
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2371
Practice Address - Country:US
Practice Address - Phone:770-974-5293
Practice Address - Fax:770-974-7285
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0107761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice